PRP Injections

As physical therapists, we try our best to rehabilitate our patients by working on our patients’ strength, range of motion and posture. However, there are times when the patients’ tissue damage is extensive that physical therapy progress plateaus. At this point, we have to consider other options and refer our patients to specialists or back to their orthopedic surgeon.


If surgery is not deemed an option, or if our patient is very adverse to the idea surgery, there are still conservative options available to attempt. One of these is PRP injections.


Platelet-Rich Plasma (PRP) injections is a form of regenerative medicine, the goal being to restore the function of tissues through tissue regeneration and repair. Physicians versed in PRP take the patients’ blood and centrifuge it to separate various blood components. A portion of this centrifuged blood will be rich in platelets, which store a number of growth factors that play a critical role in the tissue healing process. The platelet rich portion (see image) is then injected into the damaged region (be it a tendon, cartilage, or disk), usually using ultrasound guidance.


Over time, PRP has anti-inflammatory effects that can reduce chronic inflammation in a joint. PRP may also stimulate the synovium in a joint to produce more hyaluronic acid, which enhances cartilage cushioning and lubrication.


Research has been mixed historically because some studies that disprove its efficacy fail to have a multidisciplinary approach to regenerative medicine, and oftentimes ignore the importance of mechanical stimulus (such as through exercise or vibration) for growth factors in to be effective on the cellular level. However, recent results are very promising when PRP injections are combined with physical therapy in helping the patient return back to function, and more recent randomized control trials are showing improved return to sports for patients who have chronic and moderate tissue damage. (see journal articles below) More and more evidence is being collected every month, and it looks hopeful that the therapy can be covered by insurance in the future. Evidence compiled for this article include successful results for 1 year post-therapy with patients who have knee osteoarthritis, and another supporting its use in acute muscle tears and return to sports.


In order to give patients a better understanding of the physician’s side of administering PRP, we turn to Dr. Carl Balog MD, who happens to have a PRP clinic adjacent to Stride Strong Physical Therapy in Cedar Mill! Dr Balog is ananesthesiologist with over 20 years of experience and is the lead physician of Portland Pain and Spine. Read on about our Q&A on PRP injections:
Q. When should a patient consider PRP injections for their injury?


Dr. Balog: Platelet-rich plasma (PRP) uses a patient’s own concentrated platelets to augment the healing cascade.  A small amount of a patient’s blood is drawn and then spun at high speed.  This liquid is then injected around or near the area of injury being treated. The PRP at this stage contains three to five times the concentration of growth factors compared to normal human blood.  These growth factors stimulate healing. The goal is not only to relieve symptoms but to create actual healing. So when a patient has tried conservative therapies, such as rest, stretching or physical therapy, and has made little progress, they might consider PRP injections. In some cases, PRP may reduce the need for medication and/or surgery.


Which areas of the body does PRP therapy work the best on?


Dr. Balog: It has been used to treat tendon, ligament, cartilage and bone injuries, as well as arthritis.  PRP is used in rotator cuff injuries/calcinosis, degenerative joint disease of the shoulder, knees, hips, tennis elbow or in plantar fasciitis, Achilles tendon and ankle ligament injuries. Recent evidence even shows significant success when injected into painful lumbar disks!  PRP has been used in sports medicine for over a decade and has a very good safety profile.


Does the patient have to be healthy in order for the therapy to be effective?


Dr. Balog: We want to avoid injecting blood if there is a fever or general signs of infection.  We also avoid PRP in patients on blood thinners, certain cancers, and patients whose have religious beliefs against using blood products.


Could PRP injections cause any harm to a patient?


Dr. Balog: As PRP is obtained from a patient’s own blood, the risk of reaction is low. As with any injection, there is a small risk of injury to any structures in the area as well as a very small risk of infection. The use of ultrasound greatly reduces these risks.


How many doses would a patient need?


Dr. Balog: I may recommend a single injection or a series of injections based on the injury being treated and a patient’s initial response to the therapy.  Typically, patients respond well after two injections. I use ultrasound as a guide to placing the injection in my office.  This increases the likelihood of proper PRP placement near the site of injury and the odds of success.  Some patients experience mild pain and irritation of the area for several days following the injection.  We ask patients to limit motion or weight-bearing activity immediately following the injection. The use of a brace, boot or cast may be recommended during the early post-injection course. Three to seven days after the injection, patients return to normal physical activities and are encouraged to continue with physical therapy.


What are the costs for PRP therapy and can insurance cover for it?


Dr. Balog: Commercial insurance does not currently cover PRP therapy.  This may change in the future as more quality studies get published.  In certain circumstances, such as Workers Compensation and motor vehicle accidents, PRP may be covered if prior approval is obtained.   Generally speaking, the average cost per joint is between $400-600 per session, which includes follow-up and any necessary bracing. Out of pocket costs depend on the size of the joint and how many are being injected, which reflects the amount of blood being processed.
How can a patient reach you and get started with PRP therapy?

Dr. Balog: My two practice locations offer PRP injections: Portland Pain and Spine–12672 NW Barnes Road (503) 238-7246 and Nuxone–12847 NW Cornell Road (503) 372-6249. I recently opened Nuxone to allow for quick and convenient access, right next door to Stride Strong PT Cedar Mill.
Rossi et al. Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2016 Apr 16.
Raeissadat et al. Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial).Clin Med Insights Arthritis Musculoskelet Disord. 2015 Jan 7;8:1-8. doi: 10.4137/CMAMD.S17894. eCollection 2015.
Kavadar G et al. Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study. J Phys Ther Sci. 2015 Dec;27(12):3863-7. doi: 10.1589/jpts.27.3863. Epub 2015 Dec 28.
Thompson et al. Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation. Physical Therapy April 2016, Vol 96, No.4 pp 560-569.

By Alice Holland, DPT.
Alice’s Google + page.

Follow Me @

Alice Holland, DPT

Doctor of Physical Therapy, Director at Stride Strong Physical Therapy
Alice earned her Doctorate of Physical Therapy from USC in 2007, and have practiced Physical Therapy for 12+ years in the Outpatient Orthopedic Setting. Certified in ASTYM, she also has been a featured expert on Physical Therapy on numerous publications including health.com, healthline.com and yahoo.com.
Follow Me @

Latest posts by Alice Holland, DPT

Ana Lucia Pinheiro
Ana Lucia Pinheiro
02:18 20 Oct 17
This place is amazing. I am so happy I found Stride Strong PT. Alice pays attention to all of the details, she watches every single move I make, my posture, and the way I move through every exercise. She is very knowledgeable, she was able to pin-point the problems in my back and she has a plan to help me become stronger where I need. The place is brand new, huge, and has nice exercise machines. I tried a few physical therapists in the area, and Alice is TOP, second to none, and I feel super lucky to have found her. Highly recommended!!
Prashant Gupta
Prashant Gupta
01:00 02 Oct 17
Dr. Alice at Stride Strong is one of the best PTs I have come across. Her attention to detail and assessment of the root cause of injury is very good. She is excellent in evaluating pain patterns and giving a training schedule for a rehab & injury prevention, she is extremely knowledgeable. I would strongly recommend Stride Strong to anyone looking for PT. It is easily the best PT clinics in Hillsboro area.
steven zollin
steven zollin
20:57 14 Sep 17
Highly recommend Stride Strong Physical Therapy , Alice showed me proper form to assist in recovery with my shoulder and is very knowledgeable.
Lindsay Nied
Lindsay Nied
23:33 18 Dec 17
I recently had a massage from Joel at the Hillsboro location. He was able to work on an ongoing issue I have been experiencing with my back after a sports injury, and I left feeling so much better. The whole facility looked incredible, and everyone I met was friendly and welcoming. I would highly recommend Stride Strong for massage and physical therapy.
JoAnn Hatch
JoAnn Hatch
08:20 08 Nov 17
Dr. Sydney is by far the absolute best physical therapist I've worked with ever! Her expertise in designing highly effective and efficient exercise plans is beyond compare. I feel so much better as my strength and function increases. She comes up with the most brilliant and fun ideas to motivate. To my delight she even offered to come to my home in Vancouver and work with me on my own equipment including a Stott Pilates Reformer. Talk about going above and beyond! Couldn't be more grateful I found her!!!
Clare Perry
Clare Perry
21:58 23 Oct 17
A full hour of a dedicated PT professional's time without aides or techs? That's just one of the things that sets this clinic apart from others. Competent, professional, and amiable, Dr. Alice Holland and her team are the best in the area. While I generally see them at the Cedar Mill Clinic on Cornell, situational constraints took me to their new Hillsboro clinic today near Intel Jones Farm. Beautifully furnished, spacious with easy parking and access. May you continue to grow and thrive, Stride Strong!
Joyce Heideman
Joyce Heideman
08:28 11 May 18
After foot surgery I went to Stride Strong for therapy with Alice Holland. She helped me reach my full mobility again by continuously introducing new and challenging exercises. The entire staff is friendly and professional. They are always on time and do not rush. I look forward to doing 1/2 marathons again and riding my recumbent trike. Thank you Stride Strong for your care and high level of expertise.
Suad Daher
Suad Daher
20:48 28 Feb 18
The best physical therapy ever. Both JP and Sydney were a great PT, they helped me understand how I can help treat my injury and how it may have caused. And also they informed about so many techniques that I can use to help my injuries or any other injuries I get in the near future. They are both friendly and nice to talk too, and verbunformative. And there is also Krystal, she is the best front desk receptionist ever, she is nice and friendly and can easily manage your schedule based on the patients comfort if they want to schedule or not. She can help and she replies fast to any patients email. And she is easy to talk to. Thank you Stride Strong Physical Therapy.
Amanda O'Rourke
Amanda O'Rourke
21:38 15 Jun 18
In just a month I've seen great progress! I've been incorporating the exercises taught to me into my daily workout routine. Im very happy with my continued results.
Albert Szal
Albert Szal
23:43 10 Jun 18
Mary Szal here: I've had three sessions with Brittany at the Hillsboro location. I can say that she has been the most effective and instructive physical therapist I've ever experienced. Her personality, energy, knowledge and results are top notch.
Osa Phiangdae
Osa Phiangdae
00:05 22 Mar 18
Awesome place for PT. Hillsboro location has plenty of parking and very spacious. I had the pleasure to work mostly with Dr. Alice Holland and JP. I came in with a shoulder injury and thank goodness they understood what I was going through. They are the best of what they do, I would recommend Stride Strong to anyone who needs PT.
See All Reviews

© Copyright 2019 STRIDE STRONG