PRP is Not the Same at Every Practice

Never has platelet-rich plasma (PRP) therapy had more traction in the orthopedic world than it does today. After more than a decade of use, PRP—a treatment that uses your own blood and growth factors to stimulate healing—has proven its staying power.

Because of this, more orthopedic practices than ever are offering PRP as a minimally invasive, more holistic treatment option. But here’s the important truth: PRP at one practice can be vastly different from PRP at another.

The success of a PRP injection depends on many critical factors. Here are some of the most important:

1. The Experience of the Physician

PRP is a highly technique-sensitive procedure. The skill, training, and experience of the physician performing the injection can make all the difference in your outcome.

2. Ultrasound Guidance for Accuracy

PRP injections are most effective when placed precisely at the site of injury. Practices that always use ultrasound guidance ensure the highest accuracy, which translates to better results.

3. The PRP System and Preparation Process

Not all PRP systems are equal:

• The amount of blood drawn

• The method of preparation

• The sophistication of the centrifugation system
  

All of these determine how concentrated the final platelet product will be. More advanced systems can isolate a higher number of platelets, which release more healing growth factors. Think of PRP preparation as a science experiment—precision matters.

4. Pre- and Post-Injection Protocols

The success of PRP doesn’t just depend on the injection itself. What happens before and after is just as important.

• Before: Patients should be “primed” to produce the highest quality PRP possible. Your physician should provide detailed instructions and handouts, not just a casual “see you at your appointment.”

• After: Proper aftercare is crucial. Which medications and supplements should be stopped? How should you protect the injection site? When can you return to exercise or physical therapy? These details matter for healing and long-term success.

5. The Number and Timing of Injections

Some conditions require more than one injection, and the timing of these sessions can significantly impact outcomes. A practice with deep PRP experience knows how to tailor this to your condition.

6. Setting Realistic Expectations

Finally, your physician should provide clear, realistic expectations based on expertise and years of experience—not vague promises.

Choosing the Right Practice for PRP

The reality is that many orthopedic practices are now “diving into” PRP. Some have the knowledge and experience to deliver outstanding results, while others are new to the field and may not fully understand the science behind it.

At Impact Sports Medicine, we are leaders in PRP therapy:

• 15+ years of experience performing PRP procedures

• Ultrasound guidance with every injection

• Detailed before-and-after instructions for every patient

We believe PRP is too important to be treated as a “side service.” Physicians can only be excellent at a limited number of things—and if PRP isn’t a routine part of a practice, it’s unlikely they have the expertise to maximize your outcome.

If you’re considering PRP, choose wisely. We’d be happy to answer your questions and help determine if PRP is the right option for you

F. Clarke Holmes, M.D.

When Is PRP a Great Option — And When Is It Not?

Platelet-Rich Plasma (PRP) injections may be the single biggest game-changing treatment I’ve seen in nearly 25 years as a Sports Medicine and Orthopedic physician. The role of PRP is constantly expanding, and the results we see today are more exciting than ever.

But like any treatment in medicine, PRP isn’t the right answer for every situation. There are times when it can be life-changing, and other times when a different approach is more effective.

Here are some common examples we see in practice:

When PRP Is a Great Option

✅ Advanced Tennis or Golfer’s Elbow

When ultrasound shows moderate to severe tendon damage and patients are experiencing significant pain and loss of function, PRP can be an excellent choice. In these cases, PRP helps heal tears that we can clearly see on imaging.

✅ Mild to Moderate Knee Osteoarthritis

This is one of PRP’s true strengths. PRP not only reduces pain and inflammation, but also helps improve function and may even slow or stop further deterioration of the joint.

✅ Partial Rotator Cuff Tears

For patients with mild pain, good strength, and preserved motion, PRP can support healing and help avoid surgery.

✅ Insertional Gluteal Tendinopathy (Often Miscalled “Hip Bursitis”)

This common condition—especially in middle-aged to older women—causes pain on the outside of the hip, difficulty sleeping on that side, and pain with stairs or longer walks. PRP is often a great option here.

✅ Chronic Plantar Fasciitis (Lasting 3+ Months)

When rest, therapy, footwear adjustments, and medications haven’t helped, PRP can provide real relief—often avoiding the need for more invasive surgery.

When PRP May Not Be the Best Choice

❌ Early/Mild Tennis or Golfer’s Elbow

If ultrasound only shows minimal tendon changes and pain is mild, conservative options like therapy, rest, bracing, and medications usually work well without the need for PRP.

❌ Severe Knee Osteoarthritis With Significant Misalignment

If the knee is badly worn down with severe pain, bowing, or disability, knee replacement is usually the best option. PRP won’t reverse severe structural damage.

❌ Full-Thickness Rotator Cuff Tears in Younger or Middle-Aged Patients

If there’s significant loss of strength and motion, surgical repair is the better route—PRP won’t replace the benefits of fixing the tendon directly.

❌ Advanced Hip Osteoarthritis

When the hip joint is severely damaged, total hip replacement remains the gold standard.

Our Approach at Impact Sports Medicine

At Impact Sports Medicine, our goal is simple: to help you get the best possible outcome—even if that means recommending a treatment we don’t provide ourselves. We want every patient to be cared for as if you were part of our own family.

PRP is a powerful tool, but like all tools, it works best when used at the right time, in the right situation. If you’re struggling with joint, tendon, or ligament pain, we’d be glad to help you figure out whether PRP—or another treatment—will get you back to doing what you love.

A New Option for Stubborn Tendon Pain: Meet TendoNova

At Impact Sports Medicine, we know how frustrating it can be when tendon pain just won’t go away. Whether it’s tennis elbow, golfer’s elbow, plantar fasciitis, Achilles tendon pain, or even rotator cuff calcific tendinopathy, these problems can linger for months—and often don’t respond well to rest, therapy, steroid injections or medications.

That’s why we’re excited to offer TendoNova, our newest in-office, minimally invasive procedure designed specifically for chronic tendon injuries.

What is TendoNova?

TendoNova is a needle-only system that requires no incision and is performed with just a small lidocaine injection for comfort. Using an oscillating needle, we carefully break up unhealthy tendon tissue under ultrasound guidance—kickstarting your body’s natural healing process.

Here’s the best part: the treatment itself takes only 20–60 seconds.

Combining TendoNova with PRP: A Powerful Duo

On its own, TendoNova stimulates healing. But when combined with platelet-rich plasma (PRP) injections—using your body’s own concentrated platelets and growth factors—the results can be even stronger.

Think of it this way:

• TendoNova = aerating your lawn (breaking up the tough, unhealthy tissue)

• PRP = planting fresh seed (delivering growth factors directly where they’re needed)

Together, they give your tendon the “best of both worlds” for long-term recovery.

Why Choose TendoNova?

• Minimally invasive – no incision, no stitches

• Quick recovery – the procedure itself is done in under a minute

• Natural healing – enhanced when paired with your own PRP

• Cutting-edge care – we’re one of the only practices in Middle Tennessee offering this option

At Impact Sports Medicine and Orthopedics, our mission is simple: to bring you safe, effective, and innovative treatments that reduce pain and help you stay active. TendoNova is just one more way we’re doing exactly that.

F. Clarke Holmes, M.D.

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.

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 is a Game-Changer for Shoulders, Elbows, Hips and Feet

Our number one application for platelet rich plasma (PRP) injections is knee osteoarthritis.

Yet, shoulder osteoarthritis, rotator cuff and labral problems also respond very favorably to PRP.

Tennis elbow and golfers’ elbow are great applications of PRP.

Hip osteoarthritis, insertional gluteal tendonopathy and bursitis of the hip are commonly treated with great success with PRP.

Finally, in the foot and ankle, osteoarthritis, particularly of the big toe joint, Achilles tendonopathy and plantar fasciitis are common conditions we treat with PRP.

For a tendon problem, why would you choose PRP over a steroid/cortisone injection?
With a PRP injection, we use your own platelets to stimulate healing and tissue regeneration by releasing growth factors. It aims to repair the tendon, not just reduce symptoms. Steroid injections can lead to tendon degeneration or even rupture with repeated use, while PRP is safer for tendon tissue, especially with chronic degenerative tendon conditions.

What about in the case of osteoarthritis? Here’s a table that highlights the differences.

Factor PRP Steroid

Onset of relief Slower (weeks) Fast (days)

Duration of Relief Months to years Weeks

Cartilage effects Potentially protective Potentially harmful

Side effects Minimal Possible systemic and local issues

Disease-modifying? Likely No

Are you interested in improving your quality of life? Reducing your pain? Improving your function? Are you seeking the healing of damaged tissues? Stopping or slowing the deterioration of your joints? If so, then PRP is likely a very good option for you.

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

F. Clarke Holmes, M.D.

PRP: Natural/Holistic, Preventative & Effective

The trend we are seeing is in so many patients is their desire to treat their medical conditions with something more natural, less invasive, safe, effective and preventative. Well, platelet-rich plasma injections really check all of these boxes.

PRP injections have been a part of our treatment regimen for many conditions now for 15 years! Thus, PRP is not some trendy, gimmicky, unproven type of therapy.

If you have knee osteoarthritis and it’s not to the point of requiring a knee replacement, then PRP is probably your most effective option to relieve pain, improve function and stop or slow the deterioration of cartilage in your joint. Unfortunately, steroid (cortisone) and hyaluronic acid (the “gel” injections) do not have this preventative benefit of protecting your cartilage.

Of course, we believe in total body care, so physical therapy, bracing, weight loss, a customized exercise regimen, an anti-inflammatory pattern of eating and certain supplements can all play a very valuable role in treating your pain and osteoarthritis.

If you have a chronic tendon problem such as of the rotator cuff, the Achilles tendon, tennis or golfer’s elbow or plantar fasciitis, then PRP can actually heal these conditions. Steroid injections, on the other hand, often provide more rapid pain relief for these conditions, yet are almost always inferior to PRP injections in studies looking at these patients 6-12 months after these injections. Meaning, if your long-term goal is healing and persistent pain relief, then PRP is the better option.

Want to know more? Check out some of our blogs:

Insurance Companies Say PRP Is Experimental…We Sigh — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)

Five Keys to Successful Outcomes with PRP Injections — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)

PRP And The Three "Es" — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)

If you want to take the next step to help yourself in 2025, then let us be of assistance to you!

F. Clarke Holmes, M.D.

PRP: The Details Matter

More practices than ever are offering platelet-rich plasma (PRP) injections to their patients, especially those with osteoarthritis, tennis and golfer’s elbow, partial rotator cuff tears, Achilles and patellar tendonopathy and plantar fasciitis, just to name a few.

We often say, “not all PRP is the same.” There are so many details that go into the success rate of the injections. On that subject, how do you define success? Less pain, better function, healing of damaged tissue and/or the slowing of the deterioration of cartilage, especially in osteoarthritis. PRP can truly be a disease-modifying treatment, not just something to make you temporarily feel better.

Now, what details really matter?

• Experience of the physician: how long has he/she been giving PRP injections

• Accuracy of the injection: ultrasound-guidance is paramount

• Amount of blood used to produce the PRP: we’ve learned that a higher volume of blood is likely necessary to produce the optimal number of platelets

• Creation of the PRP: constructing the optimal amount of PRP to inject for each condition. Creating a mixture either rich in leukocytes (white blood cells) or poor in leukocytes

• Providing the best recommendations regarding what medications and supplements should be temporarily stopped before and after the injections

• Providing the best recommendations regarding restrictions (use of a boot, crutches, bracing, type of rest) after the PRP

• Deciding upon the optimal number and frequency of injections to give

• Working with a physician who is frequently involved in medical education on the topic of orthobiologic injections, including PRP

• Working with a physician who is transparent and communicative regarding outcomes, expectations and cost

If truth be told, only a few physicians in Middle Tennessee implement all of these details when it comes to PRP injections.

So, if you think you are candidate for this very natural, quite effective, and minimally-invasive treatment, then come see us!

F. Clarke Holmes, M.D.

Proactive Versus Reactive: Which One Are You Choosing?

We strongly encourage our patients to be proactive with their musculoskeletal health over just being reactive.

Let’s list some examples of the two different approaches:

Proactive

1. You’re trying to remain in great shape, yet your knee is starting to ache due to mild osteoarthritis. No surgery is necessary, but you want to do something that not only reduces symptoms, but also protects the knee in the long term that is likely disease-modifying. Thus, a series of platelet rich plasma (PRP) injections will meet those goals. PRP injections are one of the best treatment options for the management of osteoarthritis.

2. You’re starting to have heel pain when you first get out of bed. You suspect plantar fasciitis. Instead of ignoring the symptoms or simply relying on Dr. Google, you decide to consult with a sports medicine physician, so a comprehensive diagnostic and treatment plan can be constructed and customize for you. You realize an inexpensive ultrasound in the office can confirm this diagnosis, determine severity and help with prognosis. At that visit, you’ll be given numerous treatment options and successfully guided on your ability to continue exercising to maintain good health.

3. You have daily aches and pains, early arthritis and stiffness, but really don’t want to go on daily medications to manage the symptoms. However, you need some help making lifestyle choices as a pertains to diet, supplements and exercise choices. You understand that friends, family, and the Internet are not the optimal resources. Therefore, you decide to move forward with a physician consult so you may receive advice in great detail regarding the best supplements to choose for your particular situation, how to approach exercise and dietary choices. You understand that it is your physician’s to help you decide between what is fact and what is myth.

Reactive

1. Your heel starts to hurt after some longer walks, especially when you first get out of bed. You talk to friends who recommend rolling the heel, stretching the toes and obtaining non-customized orthotics. You continue to walk, but three months later your heel pain is worse and you limp into the doctor’s office wondering what happened. Bottom line, you now have advanced plantar fasciitis. Unfortunately, the advice you’ve received from well-intentioned others has not been the best for you. Presenting to the doctor when the symptoms first developed would’ve given you a much better outcome, as an entirely different set of treatment options would have been suggested.

2. Your arthritic knee starts to hurt and you see a bit of swelling, but you decide to keep going to the gym, rubbing Biofreeze on it and you add in some heavy yardwork over several weekends, Ultimately, you can barely bend your very swollen knee, and you’re thinking about canceling that trip to see grandkids. Of course, we are here to help you, but we could’ve avoided this major flare if we would have proactively started some treatment as soon as your knee started to ache.

So we ask the question: are you going to be proactive or reactive? Not every little ache or pain that last hours to a few days should prompt a visit to the doctor. However, do not ignore symptoms and instead, do realize that early treatment usually provides better outcomes than waiting until symptoms rise to a moderate or severe level.

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

F. Clarke Holmes, M.D.

Our 5 Best Pieces of Advice for You

Some specialty medical practices see you as a “knee,” an “ankle,” a “hip replacement,” or “that person with too many aches and pains.” At Impact, we see you as a whole person. We see you from head to toe and do our best to advise you on long-term lifestyle choices to keep you, your joints and soft tissues as healthy as possible.

Here are our current 5 best pieces of advice for you:

1) Use food to your advantage, not as a detriment: many think only of food as calories, but instead, let food be nutrition…something that can nourish your body. Choose wisely with lean meats, some plant-based protein sources, numerous fruits and vegetables and healthy fats. Really limit fried foods, fast foods, processed foods, foods high in sugars and artificial sweeteners. Don’t forget about healthy beverage choices: more water than anything, adding green tea or black coffee but keep soda and alcohol very much in moderation. Why is this important? Proper nutrition allows for healing and recovery. Poor food and beverage choices lead to more inflammation and pain.

2) Being at a healthy weight is very important for your joints and soft tissues: every 1 pound someone is overweight equals 4 pounds of extra force going through his/her lower body joints. On the positive side, you lose 10 pounds, you have 40 fewer pounds of force on your knees and other joints. Osteoarthritis of the hips and knees, plantar fasciitis and insertional Achilles tendonitis are the most common conditions we see in overweight individuals.

3) Make cost-effective medical decisions: did you know that seeing a physician employed by a hospital or one associated with a larger group practice is more expensive than seeing a physician in a smaller private practice? Why is this? It is because insurance companies and these larger organizations have negotiated higher reimbursement rates. Is this based on a higher quality care? Absolutely not! It’s just the behind-the-scenes business of medical economics, and not many patients are aware of this. An office visit at “Hospital/Large Practice X” may cost you $300. A similar and possibly even more comprehensive visit at our practice may cost you $200.

4) Stay moving, as “motion is lotion”: whether your knee or low back hurts, or you are just stiff quite often, staying mobile will help your musculoskeletal system. Don’t sit for too long. Don’t keep your hips, knees or spine in one position for too long. Set a goal for a certain number of steps each day, even if you are not classifying this as formal exercise. Walk while you talk on the phone. Choose an adjustable or standing desk if possible.

5) Find your sweet spot when it comes to exercise and activity: perhaps 2 miles of walking is too much for your arthritic knee, but 1.5 miles feels good, both during and after the walk. 25 minutes of the bike is great, 30 minutes creates pain. 2 sets of bench press with 30 pound dumbbells feels right, but 3 sets with 40 pounds causes shoulder pain. “Sweet spot” exercise is essential, especially for us middle-agers and older.

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 Don't Want Surgery But What Else Can I Do?

Fortunately, 90% of problems that come into an orthopedic clinic do not require surgery.

Approximately 80% of those conditions treated nonsurgically can be treated with traditional treatment measures: rest, activity modification, physical therapy, medications, supplements, lifestyle changes, brace, splint, a boot walker, steroid injection, etc. This is “bread and butter“ treatment administered by an orthopedic/sports medicine physician.

Now, what about that last 20% of non-surgical treatment? That’s often where we have to think “outside the box.” Let’s say in the case of osteoarthritis and tendon problems, that’s where treatment like platelet-rich plasma (PRP) injections can be very helpful. For example, in the case of knee osteoarthritis, how would you like to have less pain, less stiffness, less swelling and better function? What if we could accomplish that with a treatment that is minimally-invasive, safe, proven and natural? As a bonus, this treatment has preventative benefits, meaning we likely are slowing down the cartilage breakdown in your knee. These are the benefits seen with PRP injections.

In the case of tendon or fascia problem like a rotator cuff partial tear, tennis or golfer’s elbow or plantar fasciitis, PRP is designed to be a healing agent. We are using these growth-factor rich injections to accomplish healing, not just make you feel better like a steroid injection might.

Check out a few of our previous blogs, and let us know if we can help you!

https://www.impactsportsnashville.com/blog/2023/12/8/prp-the-gift-of-health

https://www.impactsportsnashville.com/blog/2023/9/23/5-things-you-have-to-know-if-you-have-knee-pain

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

F. Clarke Holmes, M.D.

Why Me? Why So Many Tendon Problems?

If you are 40 years old or above, it’s probably not “if” but “when” you are going to have a tendon problem. Tendons connect our muscles to bones, but as we age, they become problematic. Common tendon problems include/involve the rotator cuff, tennis and golfer’s elbow, Achilles tendon, posterior tibialis tendon and then the plantar fascia, which behaves like a tendon but technically is a ligament.

Thus, these conditions are usually a disease of the middle-aged and older. What are the causative factors for what we call tendonopathy?

-acute injury to the tendon

-overuse activities

-genetics

-inflammation

-diet

-biomechanics

-weight

So, to treat tendonopathy, we have to address these factors with genetics being an exception, as this can’t be changed.

Thus. we have to modify activities, either temporarily or permanently, especially avoiding overuse situations.

We want to reduce inflammation, and this can be achieved multiple ways: medications, steroid injections, supplements and an improved diet can all play a role. Medications and steroids can be very helpful in the short term but are not always a long-term solution. Platelet-rich plasma injections can be a great option to promote long-term management of inflammation and the actual healing of a tendon.

Biomechanics are often improved through changes in movement patterns, improved flexibility and strengthening. At times, footwear changes and orthotics can play a role as well.

As we often preach, early treatment of a tendon problem usually produces better outcomes than late treatment, but either way, we’ve got you covered. Don’t be discouraged if you have one or more tendon problems, knock on our door and we’ll be more than happy to share our expertise!

F. Clarke Holmes, M.D.

PRP: The Gift of Health

As we near the major holiday gift-giving season of the year, consider one the best gifts you can give to yourself: the gift of health! Platelet-Rich Plasma (PRP) injections are a great option for you in 2024 if you are looking to boost your orthopedic health and longevity. Here are 5 great adjectives that apply to PRP injections:

1) Safe: adverse effects and complications associated with PRP injections are exceedingly rare.

2) Effective: 80-90% of our patients that receive PRP injections have very good outcomes and are satisfied with their results.

3) Natural: these injections use your blood, specifically your platelets and your growth factors to exert their positive effects.

4) Proven: once considered experimental, there are now hundreds of studies that demonstrate clinical benefit with PRP injections.

5) Preventative: PRP injections are touted in their ability to prevent many degenerative joint and soft conditions from further deterioration.

Want to know more? Check out some of our blogs:

Insurance Companies Say PRP Is Experimental…We Sigh — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)

Five Keys to Successful Outcomes with PRP Injections — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)

PRP And The Three "Es" — Impact Sports Medicine & Orthopedics (impactsportsnashville.com)

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

F. Clarke Holmes, M.D.

Five Keys to Successful Outcomes with PRP Injections

1. Quality Equipment- we’ve chosen a PRP system created by one of the industry’s leaders in orthobiologic injections.. This is our 5th PRP system to use over the past 12 years. Thus, we are always searching for the best option to produce a high-quality PRP solution.

2. Appropriate Selection of Patients- we attempt to choose patients and conditions that are excellent candidates for PRP injections. Admittedly, not every patient is an ideal candidate, yet their options may be limited in terms of other forms of treatment, or they are willing to have PRP due to its excellent risk-benefit and cost-benefit ratio compared to more invasive treatments. Partial tendon tears, plantar fasciitis and osteoarthritis of the knee, hip and shoulder comprise 95% of our PRP injections.

3. Appropriate Pre-Procedure and Post-Procedure Instructions and Compliance-little things can be the difference between PRP succeeding or not succeeding or between a good outcome and a great outcome. For example, it’s important for a patient to be off any anti-inflammatories at least a week before and 2 weeks after a PRP injection. It’s also important to rest the treatment area, and this form of rest really varies depending on the patient and their area treated. A patient’s timetable for return to exercise and/or rehabilitation must be carefully outlined.

4. Quality Preparation of the PRP solution- not all PRP is the same. The platelet concentration and number of platelets can vary and are important aspects of the potential success of PRP. How much blood we take from the patient and the PRP system dictate these numbers. Also, we typically create a leukocyte-poor (low numbers of white blood cells) for joint injections and leukocyte-rich (higher white blood cells and the highest number of platelets) solution for tendon injections.

5. Accuracy of the Injection, Preferably with Ultrasound Guidance- using ultrasound for the injection often results in less pain, lower risk, and greater accuracy. We place the PRP exactly where it needs to be and avoid hitting other structures like bone, cartilage, nerves and blood vessels. We often say, “if you’re going to invest your time and money in this procedure, don’t you want it done as precisely as possible?”

More medical professionals are performing platelet-rich plasma injections than ever. This innovative treatment is not going away and will only evolve in the years to come. If you think you are a first-time or repeat candidate for a PRP injections, then come see us!

F. Clarke Holmes, M.D.

Tiger Woods and You!

You or someone you know may have something in common with Tiger: plantar fasciitis. Tiger dropped out of the Masters golf tournament last weekend due to severe heel pain caused by plantar fasciitis. This all-too-common orthopedic condition afflicts a huge number of middle-aged Americans every year. The most common symptoms are heel pain when first getting out of bed, when barefoot or with prolonged walking, running or sports. Here are some key “Dos” and “Don’ts” when it comes to plantar fasciitis:

What To Do When You Have Plantar Fasciitis:

1) Seek medical attention early: We have many tools in the toolbox to treat this condition, but we first need to need to confirm the diagnosis, set-up a multi-faceted treatment plan, and guide you on your prognosis. Ultrasound, which can be done in our office, is by far the best imaging study to see the plantar fascia. This factors into our concept of PIO- Proactive Interventional Orthopedics.

2) Wear good footwear at ALL times: when in the house, in the yard, at the gym, at the pool, while shopping, going to that concert, socializing with friends and at church. Good footwear means very supportive, not too flexible, and not too cheap. Cheap unfortunately often means lower quality.

3) Consider inserts/orthotics for your shoes: over-the-counter can get the job done, but you’ll need some advice on how to choose these. A high-quality athletic shoe store or a visit to your sports medicine doctor can supply that information. However, custom orthotics prescribed by your physician may really be what you need. We are fortunate to have custom orthotic specialists that work directly with our practice.

4) Consider physical therapy as it’s beneficial for most patients: many cases of PF are related to biomechanical problems, meaning that your calves are too tight, your foot pronates or supinates, your foot muscles are weak or you are overweight. Physical therapy along with weight loss in some individuals can help correct these biomechanical problems.

5) Realize that 10-20% of cases of PF will need an advanced treatment: in our practice, our first-line innovative and advanced treatment for stubborn PF is a platelet-rich plasma injection. PRP uses your own blood and the concentrated growth factors we have produced to reduce inflammation and pain while stimulating a healing response. If this fails, then we move on to a minimally-invasive surgery called a percutaneous fasciotomy using the Tenex system.

What Not To Do When You Have Plantar Fasciitis:

1) Stretch the bottom of the foot: many cases of PF involve tears in the plantar fascia. Although stretching the calf can help, stretching the bottom of the foot often irritates the fascia and can inhibit the healing process.

2) Buy expensive orthotics that are rigid or produced by an “orthotics store”: in our experience, these tend to be very uncomfortable for patients and unsuccessful in treating patients’ symptoms. Stick with an orthotics specialist recommended by an orthopedic/sports medicine physician.

3) Have multiple steroid/cortisone injections: although offered by some orthopedic doctors and podiatrists, we rarely offer these injections for PF and essentially never do more than one. Steoid injections can contribute to further tearing and often impede healing. Some patients feel better in the short term with steroid injections, but are worse in the long term.

4) Run/Walk through the pain: unfortunately, PF will just not get better if you keep doing the things that are causing the problem. So, a period of complete rest or relative rest will be necessary for PF to improve. Relative rest can mean dialing down your walking/running frequency or distance to the point that you stay below your pain threshold.

5) Become impatient: recovery from PF is often in the range of months, not days or weeks. So, once a treatment plan is in place, you’ll have to be patient. We often construct a Plan A, Plan B and Plan C. Each plan has 2-4 treatment entities within it and we insitute these for 1-2 months, judge their success and then move on to the next plan if we are not seeing the expected results.

In summary, plantar fasciitis is a condition that requires methodical treatment under the care of an experienced physician. Don’t just trust the advice from your non-medical friend, Dr. Google or YouTube. We are always here to help!

F. Clarke Holmes, M.D.

PRP And The Three "Es"

This sounds like the name of a band, right? Well, we’re referring to platelet-rich plasma (PRP) injections and three important words that start with an “E” when discussing these procedures.

First, a quick reminder that we use your own blood obtained from an arm vein, a special kit, a centrifuge and a precise separation process to create the PRP. PRP is then a great treatment choice for osteoarthritis of the knee, hip, shoulder and other joints. It’s also an effective treatment for tennis and golfer’s elbow, plantar fasciitis, Achilles and rotator cuff tendon problems, just to name a few. When considering who will perform your PRP injection, you absolutely need to consider the three Es:

Experience: At Impact, Dr. Holmes has been performing PRP injections since 2009. Very few physicians in the Nashville area can claim that level of experience. In addition, we are giving more PRP injections than ever as more and more patients are realizing the benefits of this procedure. Thus, in 2009, we may have given 1-2 PRP injections a month, and now, we give 12-15 a month on average.

Expertise: With experience comes expertise, yet expertise also comes with putting in the work. This means attending conferences, reading and interpreting studies, participating in webinars and interacting with peers who are also experts in the field. Hardly a week goes by that we don’t spend some time fine tuning our expertise in this field. Next, we’ve been pioneers in the sports medicine industry through our ultrasound-guided injections. 14 years of experience with ultrasound and over 10,000 injections later, we consider this to be an area of expertise.

Equipment: PRP is not just PRP, meaning some kits, equipment and the preparation process are better than others. Novices in the field tend to choose lower cost and lower quality PRP systems which often produce fewer numbers and a lower concentration of platelets. At Impact, we are on our 5th PRP system over the past decade. These systems continue to improve, and you deserve a high-quality option. Finally, ultrasound-guidance is paramount when having a PRP injection. Don’t you want this high-powered solution to be injected into the precise location? Without ultrasound guidance, you are proceeding “blindly” and can only hope the injection makes it to the intended location.

Considering a PRP injection for your orthopedic condition? Remember the 3 Es and let us know if we can be of any assistance to you!

F. Clarke Holmes, M.D.

What Does "Being Proactive Over Reactive" Mean?

Proactive Interventional Orthopedics (PIO)…a concept we will continue to promote. What does it mean in orthopedics to be proactive over reactive? Here are some examples and brief explanations:

Choose maintenance and more long-term injections over short-term steroid/cortisone injections: platelet-rich plasma (PRP) and hyaluronic acid injections often produce a more clinically significant and longer duration of benefit than steroid injections. For your knee and hip arthritis, tennis and golfer’s elbow and plantar fasciitis, just to name a few, choose these injections.

A course of physical therapy over exercises you simply found online: patient outcomes are generally better when you work with a physical therapist over Dr. Google or YouTube. We have fantastic relationships with physical therapists across Middle Tennessee and can work with you to find the best fit.

Regular use of supplements over prescription or over-the-counter medications: there’s a time and place for prescription meds when managing orthopedic conditions. However, for long-term management, we prefer options like curcumin/turmeric, collagen, and glucosamine/chondroitin. That being said, it’s always wise to consult with a physician before starting new supplements.

Don’t wait for your pain or disability to reach high levels before you seek treatment: orthopedic conditions treated early after the onset of symptoms and when pain and dysfunction are at a low level typically respond better to less-invasive treatments, and this early treatment can lower the risk of further damage to the joint or tissue.

Choose a specialist over a primary care physician for your orthopedics needs: PCPs work really hard and a do a great job to care for your overall health, but they do not necessarily have the expertise, the tools such as on-site imaging and advanced equipment or the time to dedicate to your orthopedic conditions.

Healthy eating patterns over a fad diet: weight loss is a vital part of the treatment plan when it comes to weight-bearing joint problems like hip and knee osteoarthritis. Through a variety of options, we can help you a structure a plan to gradually lose weight in a manner that the weight will stay off and through means that can be maintained for the long-term.

As always, let us know if we can help you overcome an injury, treat an orthopedic condition or find the pathway to greater wellness with an improved quality of life!

F. Clarke Holmes, M.D.

Five Simple Reasons You Should Consider Platelet-Rich Plasma

Let’s make this one quick and easy. Some blogs, we may hit with you great details, information rich in scientific data and opinions full of medical jargon. Today, let’s share some simple information regarding why platelet-rich plasma (PRP) injections should be on your radar if you have OSTEOARTHRITIS, TENNIS OR GOLFER’S ELBOW, ACHILLES TENDONOSIS, PLANTAR FASCIITIS, LATERAL HIP, PATELLAR AND ROTATOR CUFF TENDONOSIS, just to name a few.

1) Most of the time, it works: let’s be real, nothing in medicine works all of the time. If we see a significant benefit in 75% of patients or more, then we are all pretty happy with a treatment. In our patient population, PRP meets this criteria.

2) Most medical studies suggest a clinically significant benefit: do a “pub med” search for PRP as it relates to orthopedic conditions. Although some studies always will be too small or of lower quality, once you start to pool the data, you find that PRP is not really “experimental” any more. There are now hundreds of studies looking at patients receiving PRP for arthritis and chronic tendon problems, and the majority of these studies demonstrate a clinically significant benefit with PRP.

3) It’s both natural and safe: PRP is derived from your own blood. It’s designed to concentrate your platelets that contain your growth factors. These growth factors have many positive effects, ranging from inflammation reduction to slowing down the deterioration process within a tendon or joint. Major side effects are extremely rare, and when compared to steroid injections, prescription medications and surgical intervention, PRP is a safer treatment option with fewer adverse effects.

4) It’s a relatively quick office procedure: 5 minutes to set-up and draw the blood, 5 minutes to transfer the blood to the centrifuge system, 10 minutes to spin the blood, 3 minutes to further separate the blood components and capture the PRP, 2 minutes to prep the patient, and 1 minute to give the injection. In some instances, we may first inject a numbing medication (anesthetic) and then give that 10 minutes to work. So, in total, 36 minutes for this procedure done in the office, all in one sitting.

5) Although typically not covered by insurance, it’s likely a wise investment in your health and may save you money in the long run: the days of insurance always covering the best and most innovative procedures for orthopedic conditions are over. If PRP works for you like we expect it to, then you will potentially save money on doctor’s visits, medications, physical therapy, surgical interventions and other treatments. Not to mention that if you have not yet met your deductible, you will pay out-of-pocket for all of the other treatments “covered by insurance” that may be less effective than PRP.

In an nutshell, PRP is not for everyone and every orthopedic condition. We carefully select those patients who we think can “win the battle” with their orthopedic condition with one or more PRP injections. 20+ years of experience in sports medicine and orthopedics and 10+ years utilizing PRP have given us the knowledge to determine what patients may truly benefit from PRP injections. Come see us if you are curious!

F. Clarke Holmes, M.D.

Impact Sports Medicine and Orthopedics