2. Hyaluronic Acid (Viscosupplement) Injections
3. Orthobiologic Injections (like PRP)
PRP Is Evolving — And That’s Great News for You
/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 also 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 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: 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.
Frozen Shoulder... More Than Just a Winter Occurrence
/We’ve talked a lot about PIO (Proactive Interventional Orthopedics) recently and this concept really applies when it comes to a frozen shoulder, also known as adhesive capsulitis. This is a condition most commonly seen in middle-aged women around the time of menopause with the average age of a frozen shoulder being 51.
It starts as shoulder pain, often unrelated to a particular injury or overuse situation, and is followed by a very stiff shoulder with loss of motion. Although a frozen shoulder can be a self-limiting condition, with our interventions, we can greatly expedite the recovery process while alleviating pain.
Other risk factors for adhesive capsulitis include thyroid disease, diabetes and recent shoulder surgery. In the early “pain” stage, it’s often difficult to determine whether a patient has a frozen shoulder, osteoarthritis, or rotator cuff and/or biceps tendon problem. An MRI can be helpful, especially to see tendon or joint pathology, but in the presence of isolated adhesive capsulitis, the MRI can be normal or near normal. The next stage is the “stiff” or “frozen” stage, highlighted by the loss of motion both actively (what the patient can do) and passively (how someone else can move the shoulder). The final stage is the “thawing” or “recovery” stage. Each stage typically last 2-6 months, and early treatment often shortens these stages.
Being proactive and interventional often means an ultrasound-guided steroid injection into the joint. Without ultrasound guidance, it is often very difficult to achieve accuracy. This tends to be a very inflammatory condition, and thus, the potent anti-inflammatory effects of the steroid can provide rapid relief of pain. Early treatment within the first few weeks or months of the onset of the shoulder pain is the optimal path to a faster and more complete recovery. After that steroid injection, a rehab program, often made much more effective by the steroid injection, is the mainstay of treatment. 20% of patients with a frozen shoulder develop the same condition on the opposite shoulder within 5 years, so if pain in the other shoulder develops, it’s wise to seek treatment early.
Check out this brief article:
Steroid injection may be the best medicine for frozen shoulder - Harvard Health
If you think you may have a frozen shoulder, let us use PIO to help you!
F. Clarke Holmes, M.D.