A bone health program to prevent fractures, and platelet-rich plasma (PRP) injections for overuse injuries, joint arthritis and other tendon and ligament injuries are among the nonsurgical interventions offered by Norton Orthopedic Institute.

Platelet rich plasma therapy

Patients with orthopedic injuries such as tennis elbow or chronic joint arthritis often improve with platelet-rich plasma (PRP) injections, a nonsurgical option with an excellent track record and that uses the body’s own healing powers.

Blood platelets are the first responders to injury, helping to form clots and prompting the release of growth hormones. With PRP therapy, a patient’s blood is filtered, concentrating the platelets. This platelet-rich plasma is injected back into patient at the site of the injury.

Ryan E. Modlinski, M.D., focuses on nonsurgical orthopedic sports medicine at Norton Orthopedic Institute. He is also the head team physician for the University of Louisville baseball team

“PRP generally is used when current treatments are not working or if things have become chronic in nature and are not responding to other treatments,” Dr. Modlinski said.

Tendon overuse injuries like patellar or achilles tendonitis, rotator cuff injuries, smaller ligament damage and chronic joint arthritis respond well to PRP injections, which were used first in the veterinary world and then in Europe before being adopted in the United States.

Overuse injuries can go untreated for years, with the tissue becoming stagnant and dysregulated, while anti-inflammatories that patients take for the pain associated with these injuries actually impede the healing process, according to Dr. Modlinski. PRP helps treat the injury as “new,” promoting healing.

“By concentrating those growth factors to eight to 12 times normal concentration, we’re hoping for a super-robust healing effect,” Dr. Modlinski said. “It’s always coupled with physical therapy afterward. I always tell my patients, It’s not a magic bullet. Tendons and muscles respond well to controlled stress of physical therapy.”

Patients undergoing PRP therapy do not take anti-inflammatories for five to seven days before the procedure and seven to 14 days after, meaning patients temporarily can experience more pain as the body heals.

In higher-level athletes, PRP joint injections can speed recovery, allowing them to return to competition more quickly.

“When your star player is not on the field for three or four extra weeks, that matters,” said Dr. Modlinski, adding that he treats a lot of both chronic and sudden injuries on the UofL Cardinals baseball team.

Patients with cancer, or those who are immune-compromised or on immunosuppressants should not undergo PRP joint injections, nor should those on long-term prednisone or with low platelet counts.

Because PRP therapy augments the body’s natural healing ability, patients who are less healthy — such as smokers or people whose diabetes is not well controlled — will not do as well. In these patients, correcting the underlying health conditions might result in some healing without PRP.

There are limitations to the types of injuries PRP joint injections can repair. For example, PRP won’t work on serious injuries like high-grade or full-thickness tears or severe knee arthritis, according to Dr. Modlinski.

PRP injection cost

Most insurers are not covering PRP joint injections, meaning patients pay the $500 cost out of pocket. For patients experiencing chronic injuries or arthritis, many find the price well worth it.

Bone health

All women over 65 and any patient who has had a fragility fracture — a fracture resulting from minimal or no trauma — can benefit from the bone health program. Providers in the program can order bone density scans and other tests and provide all the appropriate treatments in the office. Modalities for fracture prevention can include medications, exercise and dietary changes.

“Our goal is to prevent a hip or vertebral fracture,” said Robin G. Curry, M.D., a specialist in nonsurgical orthopedics and sports medicine at Norton Orthopedic Institute. “The morbidity and mortality and loss of independence after a hip fracture is really significant.”

Women lose up to 20% of their bone mass in the five to seven years after menopause. Significant loss in bone mass also can affect men over 50.

“Osteoporosis is undertreated. It’s a silent disease until the presence of a fracture,” Dr. Curry said.

The most common sites for fragility fractures are the femoral neck, distal radius, proximal humerus and vertebrae.