PRP: Why the Details Matter

Platelet-rich plasma (PRP) injections are becoming more and more common. Patients with osteoarthritis, tennis or golfer’s elbow, partial rotator cuff tears, Achilles or patellar tendinopathy, and plantar fasciitis — just to name a few — are often hearing about PRP as a potential treatment option.

But here’s something we tell our patients all the time: not all PRP is the same.

The success of a PRP treatment depends on many important details, and “success” can mean more than just short-term pain relief. For many patients, PRP can:

• Reduce pain

• Improve function

• Support healing of damaged tissue

• Slow cartilage deterioration in osteoarthritis

That’s why PRP has the potential to be disease-modifying — not just symptom-relieving.

What Details Really Matter?

✔ Experience of the physician – How long have they been performing PRP injections?
✔ Accuracy of the injection – Ultrasound guidance is key to making sure the PRP is delivered precisely where it’s needed.
✔ Amount of blood drawn – Using a higher volume can help produce the optimal number of platelets.
✔ PRP preparation – Should the PRP be rich in white blood cells or poor in them? The answer depends on your specific condition.
✔ Medication & supplement guidance – Some should be stopped before and after the procedure for the best results.
✔ Aftercare recommendations – Whether it’s rest, bracing, or temporary use of crutches or a boot, good guidance makes all the difference.
✔ Number & frequency of injections – A tailored plan is essential.
✔ Ongoing education – Physicians who teach and stay up to date on orthobiologic treatments bring that expertise to your care.
✔ Transparency – You deserve clear communication about outcomes, expectations, and cost.

Why Choose Us?

The truth is, only a handful of physicians in Middle Tennessee take all of these details into account. That’s what sets our practice apart.

If you’re considering PRP — a natural, effective, and minimally invasive treatment — we’d love to talk with you about whether it’s the right option for you.

F. Clarke Holmes, M.D.

PRP: Natural, Preventative & Proven

More and more patients are telling us they want treatments that are natural, less invasive, and focused on healing — not just masking pain.

That’s exactly where platelet-rich plasma (PRP) comes in.

We’ve used PRP in our clinic for over 15 years, and it’s helped hundreds of patients avoid surgery, reduce pain, and heal from chronic conditions. This is not a trendy or unproven therapy — it’s a powerful, evidence-based treatment that works with your body to stimulate repair.

💥 For Knee Osteoarthritis

If your arthritis isn’t yet at the point of needing a knee replacement, PRP may be your most effective option to:

• Reduce pain

• Improve mobility

• Slow or stop cartilage breakdown

Steroid shots and gel (hyaluronic acid) injections may offer short to medium-term relief, but they don’t protect your cartilage the way PRP can.

🎯 For Chronic Tendon Injuries

PRP can help actually heal conditions like:

• Rotator cuff tendonitis

• Tennis or golfer’s elbow

• Achilles tendon pain

• Plantar fasciitis

  
  

While steroid injections might ease pain quickly, studies show PRP gives better long-term results — with more lasting pain relief and true tissue repair between 3 and 12 months.

🧘‍♂️ Whole-Body Support

Of course, we take a comprehensive approach to your care. PRP works best when combined with:

• Physical therapy

• Weight loss (if appropriate)

• Bracing

• Anti-inflammatory nutrition

• Targeted supplements and exercise

  
  

Ready to Take the Next Step?

If 2025 is the year you’re ready to invest in healing, not just managing, let’s talk. PRP might be exactly what your body needs.

F. Clarke Holmes, M.D.

“Orthopedic Maintenance”

For years, patients have been told there’s nothing to do for arthritis until they’re ready for surgery. But that couldn’t be further from the truth.

Think about your car—do you only take it to the shop when it breaks down? Of course not! You get oil changes, tire rotations, and routine inspections to avoid major repairs. So why wouldn’t you do the same for your joints?

Welcome to orthopedic maintenance.

Just like your car, your knees (and other joints) need attention before things break down. That means treating pain and stiffness early—not just chalking it up to “getting older.”

Here’s how we help maintain your joints and avoid or delay surgery, especially for knee arthritis:

1. Steroid (Cortisone) Injections

Quick relief for pain and swelling—great for flare-ups or important life events. These can also be a smart option for patients who aren’t good candidates for surgery

2. Hyaluronic Acid (Viscosupplement) Injections

Think of these as your “oil change” injections. They cushion and lubricate the knee and can give relief for 4–12 months. Safe, effective, and often covered by insurance.

3. Orthobiologic Injections (like PRP)

These are your game changers. Platelet-Rich Plasma (PRP), made from your own blood, is backed by hundreds clinical studies. They help reduce inflammation, ease pain, improve function, and likely slow down cartilage damage. We’ve been doing these for almost 15 years with great results. These typically provide the longest lasting relief of 1-2 years in most patients. 

The Bottom Line:

Arthritis isn’t all-or-nothing. There’s a lot we can do before surgery. And like dentists and primary care doctors, orthopedic specialists are now focusing on preventive care—not just reacting when things get bad.

If you’re ready to be proactive about your joint health, we’re here to guide you every step of the way

F. Clarke Holmes, M.D.

PRP Is Evolving: Here's How

One of the most exciting things about platelet-rich plasma (PRP) therapy is that it’s always improving. This isn’t a static treatment. It continues to evolve through better science, smarter techniques, and new technology.

I’ve been using PRP since 2011, and today’s approach looks very different from when I started. At a recent regenerative medicine conference, I had the chance to learn from national experts, exchange ideas with peers, and explore the latest advances in PRP and stem cell therapy.

What’s Changing with PRP?

We’re upgrading our PRP system to deliver a higher concentration of platelets to the areas where you hurt. That means more growth factors—natural healing signals that reduce inflammation, encourage repair, and help preserve tissue.

More Platelets = More Power to Heal

In addition to increased platelets, we’re now able to add important components like:

• Alpha-2 macroglobulin (A2M): A protein that helps protect cartilage and reduce inflammation.

• Extracellular vesicles (EVs): Tiny messengers that carry proteins and RNA to promote healing and calm inflammation.

These additions enhance the effectiveness of PRP—especially for joint pain, soft tissue injuries, and degenerative conditions.

Better PRP. Better Results.

If PRP has helped you before—or if you’ve been considering it—this is a great time to revisit it. With these upgrades, we’re seeing even greater potential to relieve pain, improve function, and support long-term healing.

And we’re not stopping here. Stay tuned as we begin to introduce autologous (your own adipose/fat tissue) stem cell therapies into our practice soon.

F. Clarke Holmes, M.D.

PRP Means Prevention

If there is a relatively low-risk and minimally invasive option for cancer prevention, would you choose to do it? If there is a similar option to reduce your risk of heart disease, would you do it? These would be potentially life-saving measures.

Now in the case of orthopedics, we are talking more about quality-of-life saving measures. Platelet-rich plasma (PRP) is one of those options.

We know that PRP is very beneficial in terms of reducing symptoms and improving function in most patients, yet did you know that it has also has a preventative benefit? Slowing the deterioration within your joint, particularly of the articular cartilage, is a benefit of the PRP.

How does being in less pain sound? What about being able to go up and down stairs much more easily? What about being out to enjoy longer walks and hiking? What about enjoying your grandkids with less pain during and afterwards?

What about more fulfilling trips to the gym? What about using fewer prescription medications to manage your symptoms? These are the goals of PRP, especially when we are treating osteoarthritis. When we are treating most tendon problems like of the rotator cuff, tennis/golfer’s elbow, lateral hip and the Achilles, the goal of PRP is not only to feel better, but actual healing.

This week, we repeated PRP on a patient with moderate knee osteoarthritis (OA) that last had PRP with us 5 years ago. Her benefit has lasted that long. This week we updated x-rays on a patient with knee OA and noted that in the last 2 years, his x-rays have not changed. This means no substantial loss of cartilage. In contrast, the average OA patient is losing 4%-6% of cartilage per year. What if we can change that to 0%-2%? Would you take it? If so, come see us, as we’re doing more PRP than ever, and the results remain very promising.

F. Clarke Holmes, M.D.

PRP Vs. Stem Cell Injections

We often get the question when patients come in looking for nonsurgical treatment of osteoarthritis or a chronic tendon problem: “How do I choose between a platelet-rich plasma (PRP) and stem cell injection?”

First, let’s define the differences: PRP comes from your own blood and involves a simple blood draw from an arm vein. Stem cell injections are prepared after bone marrow or adipose (fat) tissue is extracted from a patient. Obviously, the PRP preparation is simpler, less invasive and lower risk for the patient. Venipuncture takes about 2-3 minutes, whereas obtaining bone marrow involves inserting a larger needle-like device into the iliac crest (bone at top/back of the pelvis) and takes about 10-15 minutes or longer. Obtaining adipose tissue from the lower abdomen is a more complex and time-consuming procedure, often requiring about 30-45 minutes.

Both types of injections have the potential to reduce pain by reducing inflammation and promote healing. PRP uses a variety of growth factors, while stem cells utilize mesenchymal signaling cells and may have a greater potential to regenerate tissue. That being said, we are often using these injections for osteoarthritis, which is a cartilage deficiency problem. At this time, it is debatable whether any type of injection can regenerate cartilage.

What about success rates? Well, the jury is still out regarding which option is better. The good news is that in the large majority of studies, both PRP and stem cell treatments result in less pain and better function. Soft tissue problems like tendons and ligaments often demonstrate an improved or healed appearance on imaging studies. Some studies suggest that PRP and stem cell injections produce equal outcomes in the treatment of knee osteoarthriitis, while some suggest stem cells have better results. For now, we are putting our eggs in the PRP basket exclusively. Why is that?

-PRP is less-invasive, lower risk and faster to prepare

-PRP has a longer track record of use and success

-Although neither are covered by insurance, stem cell injections tend to be 3-10x more expensive than PRP injections. Example: $1000 for PRP on the average versus $5000 for a stem cell treatment.

We often state that PRP injections are like buying a Honda: safe, reliable, and gets the driver from Point A to Point B quite well. Stem cell injections are like a Maserati: fancy, expensive and unique but don’t necessarily get you from Point A to Point B any better or faster.

In summary, we anticipate that the application of stem cell treatments in the U.S. will continue to expand as studies demonstrate increased success and safety, while preparation will become easier, and the cost will decrease. Until then, PRP will be our successful “go-to” orthobiologic injection.

Want more info?

Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis - PubMed

Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial - PubMed

Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 1 Year: A Prospective, Randomized Trial - PubMed

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

5 Things You Want to Know If You Have Knee Pain

1. Three factors play a role in knee pain: structural, biomechanical and environmental. Structural means damage, biomechanical means abnormal tracking or loading within a joint or tendon because of misalignment, weakness, and/or inflexibility. Environmental typically means inflammation within the joint or tendon. When formulating a treatment plan for you, we typically want to address one or two of these factors initially. Unless you have major damage, we’re normally not treating structure initially, as that results in a surgery.

2. Age often plays a role in these different factors: in the absence of injury, in patients under 20 years of age, the problem tends to be biomechanical. In patients ages 20 to 40, the problem tends to be biomechanical and inflammatory. In patients older than 40, structural, biomechanical and inflammatory are typically all playing a role.

3. Being proactive in the care of your knee problem usually produces better outcomes than being reactive. This means integrating treatments early on and not waiting until you have major pain or disability to see a physician. We term this “PIO,” Proactive Interventional Orthopedics.

4. Meniscus tears are commonly found on MRIs and may or may not be a source of pain. For decades, the trend was to treat these surgically, typically arthroscopically, removing the torn piece of meniscus. There’s now a trend towards repairing the meniscus tear, when possible, but only about 10% can be successfully repaired. Thus, surgery for meniscus tears, especially those age 40 and above, is becoming less popular. On occasion, surgery is the better choice, but treating these initially nonsurgically is usually the best way to start. We often tell patients “a little torn meniscus is better than less meniscus,” especially long term. Less meniscus often equals greater arthritis.

5. Three types of injections can be used for most knee problems: steroid, hyaluronic acid, and orthobiologics. Orthobiologics include platelet-rich plasma (PRP) and stem cell injections. Each of these injections can be reasonably good choices, but for long-term success, PRP is likely your best option in terms of producing favorable outcomes, modifying the disease process, and these are often the most cost-effective option. Now, we are adding protein concentrate to many PRP injections, utilizing your excess plasma that we previously would just discard. Stay away from “stem cell” injections that are ordered by physician’s or chiropractic offices and do not come from you own bone marrow or fat. These are often being used inappropriately, and patients are charged exorbitant amounts of money to have these injections.

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

Harness the Power of Protein Concentrate Added to your PRP

We are always finding innovative ways to help our patients, especially those with osteoarthritis. Platelet-Rich Plasma injections have been very successful, yet now we have another option to boost the benefits of PRP. We call this “Protein Concentrate.” By filtering the additional plasma after your blood is centrifuged, we are able to trap a high concentration of proteins that can also significantly relieve the symptoms of OA and potentially slow the deterioration of the cartilage in the joint. Two of these proteins are Alpha-2-Macroglobulin (A2M) and Interleukin-1 Receptor Antagonist Protein (IL-1ra).

A2M is the key to slowing the progression of osteoarthritis. A2M is a powerful chemical in destroying proteins that cause arthritis that captures and inactivates the three major chemicals that lead to joint breakdown and cartilage damage. It is also reported that A2M can act as a powerful anti-inflammatory and aid in pain management.

Research on IL-1ra has shown that it also plays a role in slowing the progression of osteoarthritis in joints.  

Who should consider adding Protein Concentrate to their PRP injections? We believe that those with repetitive swelling in the joint are the most likely to benefit from the addition of the protein concentrate to the PRP.

Want to know more about PRP?

Learn about the key details of PRP here

How is PRP simple and not-so-simple? Read here

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

PRP For Knee Pain: Almost A No-Brainer

Knee pain is often caused by a meniscus tear, osteoarthritis, patellar tendinopathy, low-grade ACL or MCL sprain or some combination of these.

Don’t want surgery, don’t need surgery or already had surgery with a less than satisfactory outcome?

Platelet rich plasma (PRP) has been a star in the world of orthopedics, particularly as it pertains to knee conditions.

Once considered experimental, this innovative, minimally-invasive treatment using your own blood and concentrated growth factors is now is becoming a standard-of-care treatment for many knee conditions.

Over 45 studies have demonstrated clinically significant benefit in the treatment of knee osteoarthritis (OA). The overwhelming majority of studies demonstrate that PRP is more effective in the long-term when compared to steroid or hyaluronic acid injections for knee OA.

Want something safe, natural, effective, and a disease-modifying intervention that will relieve pain, improve function, provide stability and/or healing for tissues that can be done in the office? Then PRP can be a great option for you.

I've been giving ultrasound-guided PRP injections for 15 years. I’ve spent countless hours on the educational process, training and fine-tuning of techniques to make this a excellent option for our patients. I’ve been a patient myself, receiving PRP for shoulder and knee conditions and I've experienced the success firsthand.

Want to know more about PRP?

Learn about the key details of PRP here

How is PRP simple and not-so-simple? Read here

If you think you may be a candidate or want to discuss further, then

come see us. We are always happy to help!

F. Clarke Holmes, M.D.

Do I Need a Knee Replacement?

Your 55 year-old knee is hurting and your brain immediately asks the question, “Do I need a knee replacement?”

An x-ray demonstrates moderate to severe osteoarthritis and thus, it’s time for a knee replacement, right? Not necessarily. It’s amazing how many patients have severe findings on their x-rays but minimal to mild pain and excellent function. Therefore, we always say, “Treat the patient, not the x-ray.”

Ok, now your pain has been running 5-7 out of 10 for weeks to months. Therefore, it’s time for a knee replacement, right? Well, pain is certainly a factor in this decision; however, we have many nonsurgical tools in the toolbox that will reduce or eliminate pain for extended periods of time.

Finally, you’ve been episodically limping now for several weeks. You suppose it’s time for a replacement, right? Persistent dysfunction is another reason to have a knee replacement, but function can often be significantly improved without the need for surgery.

To overcome the symptoms and dysfunction of knee arthritis, three factors can be addressed: the environment, the biomechanics and the structure. Only surgery can change the structure, yet significant improvements in the environment and biomechanics can often delay or eliminate the need for knee replacement.

How do we do this? The environment is best changed by injections such as platelet-rich plasma, an anti-inflammatory pattern of eating, supplements and occasionally medications.

The biomechanics can be improved through physical therapy, certain forms of exercise, bracing and changes in footwear.

So in summary, knee replacement can be the right option for many patients and produce successful outcomes in most patients, yet in 80-90% of the patients that walk (or limp) into our office, nonsurgical treatment will be quite effective.

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

PRP: The Simple and Not So Simple

Many of you are either very familiar or somewhat familiar with platelet-rich plasma injections commonly known as PRP. These are great options for osteoarthritis of a joint, a chronic tendon problem as well as some ligament and fascia problems. Our top conditions treated with PRP include knee osteoarthritis, tennis & golfers’ elbow, plantar fasciitis, rotator cuff tears and Achilles tendon conditions.

When it comes to PRP, here are the simple and not so simple :

Simple

-This is an office procedure, that from start to finish, only takes 45 minutes or less

-A simple blood draw from an arm vein is typically painless

-For a joint injection, pain afterwards is typically very mild

-Risks are exceedingly low as abnormal bleeding, infection, a blood clot or nerve damage are basically nonexistent.

Not So Simple

-We have been performing PRP injections for nearly 15 years. Literally hundreds of hours have been poured into training and fine-tuning the knowledge and skill set it takes to be highly competent to perform this procedure

-Some of our patients have very small veins. Fortunately, we have developed a skill set of ultrasound-guided venipuncture, making blood draws much more successful and less painful on those more challenging patients

-Ultrasound guidance, in our opinion, is a must when giving PRP injections. If you want these growth factor rich platelets to make it to the intended location with great accuracy, then ultrasound guidance is necessary. This is a skill set we have developed over the past 16 years

-With some soft tissue PRP injections, such as partial tears of tendons, we have to prepare our patients that there will be a spike in pain after the procedure, often for one to two weeks. Fortunately, the pain is typically not as significant as it would be if you had a surgery

-Finally, patients have to be patient! PRP exerts its positive effects very gradually. Most patients are seeing a benefit within one to two months, and the maximum benefit often is seen between 6 and 12 months. Thus, we have to advise our patients that with many orthopedic conditions, there is no “quick fix”

Ultimately, PRP can be simple and not so simple, depending on your perspective. Generally speaking, we leave the simple part up to the patient, and we will handle the not so simple aspects of the procedure.

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.

I Have Knee Arthritis. Can I Still Run?

The answer is, “yes,” “maybe” or “no.” Thus, it really depends on your situation, and fortunately, a period of relative rest may only need to be temporary.

Here’s the really good news: several recent studies have indicated that running a reasonable number of miles does not cause knee osteoarthritis and may actually have a protective effect.

If you are a runner and your knee is symptomatic, then our role is to help you reduce or eliminate your symptoms and safely return to running. We know that running has numerous health benefits, not only including protection of the joints, but also calorie burning, weight control, improvement of cardiovascular health and many mental health benefits.

As a patient though, it’s sometimes difficult to know when you need to stop running for a while, what’s a reasonable amount of running for your body and what treatment options may be available to not only reduce your symptoms, but also to protect your knees on a long-term basis.

That’s where we come in! We love treating runners and understand how you think. We typically focus on a nonsurgical and minimally-invasive approach to your care.

Physical therapy, bracing, footwear changes, custom orthotics, medications, supplements, and various injections can all play a role in the treatment of knee osteoarthritis. One of the best long-term treatment options, especially for those with mild to moderate osteoarthritis, would be platelet plasma (PRP) injections. These can have a very protective effect for the knee, and not only by reducing symptoms, but also by slowing or stopping the deterioration of the cartilage within the joint. Only a couple weeks of rest are typically required after these PRP injections.

Check out a few blogs on PRP as well as running as it relates to knee osteoarthritis:

https://www.impactsportsnashville.com/blog/2023/8/5/our-top-5-treatments-for-knee-oa

https://www.impactsportsnashville.com/blog/2023/5/12/five-keys-to-successful-outcomes-with-prp-injections

https://pubmed.ncbi.nlm.nih.gov/36875337/

As always, let us know if we can be of assistance to you!

F. Clarke Holmes, M.D.