American Journal of Student Research

Research Article

Efficacy of Platelet-Rich-Plasma in Accelerating Muscle

Injury Recovery in Athletes: A Literature Review

Aaron Bedi

The Overlake School, 18119 NE 110th Way, Redmond, Washington, 98052, USA

ABSTRACT

Muscle strains are the most common injury, leading to enormous amounts of time lost for training
and participation in competitions, with long recovery periods and compromising the season play,
especially when seniors are involved. The treatment of muscle injuries includes the traditional use of
rest and ice compressions, but also involves the addition of physical therapy to improve the patient’s
condition and to help the rehabilitation of the acquired trauma. These injuries occur when muscle
fibers are overstretched or torn, resulting in pain, swelling, and limited movement, which can impact
both individual performance and overall team success. As a response to the limitations of conventional
therapies, platelet-rich plasma (PRP) therapy has emerged as a promising treatment option, involving
the injection of a concentrated solution of platelets derived from the patient’s own blood into the
injured area, in order to promote tissue healing and regeneration. While some studies suggest that
PRP injections can lead to faster recovery times compared to traditional treatments, others indicate
no significant benefits. This highlights the variability in outcomes influenced by factors such as injury
type and PRP preparation methods. This literature review critically examines the current evidence
regarding the efficacy of PRP injections in reducing recovery time for muscle injuries in athletes,
aiming to provide a comprehensive understanding of its potential benefits and limitations, and to
explore the hypothesis of whether PRP injections can effectively accelerate recovery for athletes with
muscle strains and sports injuries.

Keywords: Platelet-Rich-Plasma (PRP); Muscle Strains; Sports; Injections

INTRODUCTION

Muscle strains represent a significant challenge in strains ranges from 10-55% across various sports,
athletics, accounting for a substantial proportion of all highlighting the prevalent nature of this injury type.
sports-related injuries. The incidence rate of muscle These injuries occur when muscle fibers are overstretched
or torn, leading to pain, swelling, and limited movement.
The impact of muscle injuries on athletes and sports
teams is substantial, affecting individual performance,
Corresponding author: Aaron Bedi, E-mail: [email protected].
team dynamics, and overall success in competitions (2).
Copyright: © 2024 Aaron Bediu. This is an open access article distributed In 16 major international athletics championships,
under the terms of the Creative Commons Attribution License, which muscle injuries were the most common injury type,
permits unrestricted use, distribution, and reproduction in any medium, constituting 41% of total injuries. For example, in soccer,
provided the original author and source are credited.
Received October 12, 2024; Accepted November 13, 2024
muscle injuries account for approximately 31% of all
https://doi.org/10.70251/HYJR2348.246671 injuries, with a male professional-level soccer team of

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 Platelet-Rich Plasma for Accelerating Muscle Injury Recovery in Athletes

25 players expecting about 15 muscle injuries each sports medicine (10).

season. This results in an average of 223 days of absence, This literature review aims to critically examine
148 missed training sessions, and 37 missed games. current evidence regarding the efficacy of PRP injections
Additionally, muscle injuries account for an estimated in reducing recovery time for muscle-related injuries. By
15% of track injuries, 18% of basketball injuries, and analyzing available research, this review also aims to
46% of injuries in American football, with 22% occurring provide a comprehensive understanding of the respective
during games. Hamstring injuries alone result in an benefits and limitations of PRP therapy in sports medicine.
average hiatus of 90 days and 15 missed matches per club Specifically, the hypothesis: “Do PRP injections accelerate
per season in elite soccer (6). recovery time for athletes with muscle strains and sports
The recovery time for muscle strains can vary injuries?” will be explored.
widely, from a few days to several months, depending
on the severity of the injury and the individual’s healing METHODS
capacity. On average, recovery usually takes 2-3 weeks,
causing athletes to lose crucial training and competition My exploration of platelet-rich plasma (PRP) therapy
time. Traditional treatments for muscle strains include was motivated by an interest in its application for muscle
conservative measures including, rest, ice, compression, strain injuries in athletes. A review of the existing literature
along with physical therapy and anti-inflammatory revealed a lack of studies specifically addressing this
medications​. However, the prolonged variation in recovery topic, particularly concerning muscle injuries sustained
times has led physicians to explore novel and potentially during athletic activities. This limited body of research
faster-acting treatments (7). highlights the need for further investigation into the
Platelet-rich plasma (PRP) therapy has emerged as a effectiveness of PRP therapy in this context.
promising treatment for sports-related muscle strains and The methodologies employed in the studies varied
injuries. PRP therapy involves injecting a concentrated significantly. While many investigations involved human
solution of platelets from the patient’s own blood into participants who experienced accidental injuries, some
the injured area. Platelets contain a significant amount studies utilized animal models, intentionally inducing
of growth factors that are believed to help promote muscle injuries to assess the effects of PRP treatment. This
tissue healing and regeneration. In various medical fields diversity in experimental design reflects the challenges
including orthopedics, dermatology, and dentistry, PRP researchers face in establishing a consistent understanding
has demonstrated to be widely efficacious, strengthening of PRP’s therapeutic potential for muscle injuries.
the rationale for its application in treating sports-related In selecting studies for my literature review, I focused
injuries. For instance, PRP has been effectively used to on those that specifically examined muscle injuries
treat chronic tendinopathies and accelerate bone healing resulting from sports-related activities. I prioritized
in common dental procedures (8, 9). credible sources, including PubMed and the American
Despite growing interest in PRP therapy, its Journal of Sports Medicine, ensuring that each selected
effectiveness in reducing recovery time for muscle study featured a substantial sample size and credible
injuries in athletes remains uncertain. While some studies results. This careful selection process was essential to
report positive outcomes, others find no significant enhance the credibility of the findings presented in my
differences from traditional approaches. Additionally, review, ultimately contributing to a more comprehensive
PRP injections, while generally considered low-risk, do understanding of PRP therapy’s role in athletic recovery.
carry some potential adverse effects that athletes should In most clinical studies, PRP is prepared from
be aware of. One significant risk is infection, which can the athlete’s own blood, which is then centrifuged
occur if the injection site is not properly disinfected. to concentrate the platelets. Injections are typically
Similarly, nerve or tendon injuries as well as bruising and administered within a few days of the injury occurrence.
inflammation can occur secondary to improper needle Follow-up assessments are conducted at regular intervals
placement. Overall, while serious complications are rare, to track recovery progress, with the primary outcome
it is essential for athletes to discuss these risks with their usually being either time to return to play or full recovery.
healthcare provider to ensure informed decision-making Varied approaches, including animal models, human
regarding PRP therapy. Overall, this inconsistency has led clinical trials, and meta-analyses are reviewed in this
to ongoing efforts and clinical trials to better understand paper, providing a comprehensive view of PRP’s effects
the potential benefits and limitations of PRP therapy in in athletic populations.

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 Platelet-Rich Plasma for Accelerating Muscle Injury Recovery in Athletes

Key Studies group. The peak isometric torque for each animal was
Study One: This study was conducted in a controlled measured before injury (set as 100%; mean ± SD torque:
laboratory setting using rat models. The rats were injured 44 ± 5 Nmm). Two injury protocols resulted in significant
by either a single (large strain) or multiple (small strain) muscle function loss, followed by gradual recovery. In
lengthening contractions. The tibialis anterior muscle the multiple repetition protocol, PRP treatment led to a
was subjected to one of three protocols: PRP injections, marked improvement in contractile function at days 7 and
platelet-poor plasma (PPP) as a control, or no intervention. 14, effectively reducing the time for full recovery from 21
Muscle contraction torque (measurement of the rotational days to 14 days (Figure 1) (1).
force generated by dorsiflexor muscles of the rats) was Maximal torque was measured in each animal before
measured as the primary outcome (1). and immediately after injury, as well as at selected time
Study Two: A randomized controlled trial in a clinical points post-injury. After a single repetition through a
setting with human athletes was performed, evaluating the 90-degree arc of motion, a significant drop in torque was
efficacy of autologous PRP injection for acute hamstring observed, followed by gradual recovery to full function
injuries. The study involved 28 athletes with confirmed by day 7. For multiple repetitions through a 60-degree arc
acute hamstring injuries (grade 2a based on the Functional of motion, PRP significantly impacted days 7 and 14, with
Assessment Scale). Participants were randomly assigned the injured muscle returning to pre-injury strength. This
to PRP (n=14) or the control group (n=14), where the PRP study demonstrated that PRP could reduce recovery time
group received a single PRP injection under ultrasound
guidance followed by a structured rehabilitation program.
Meanwhile, the control group underwent the same
rehabilitation program without PRP. The primary outcome
was the time to return to play, with additional assessments
of pain severity using the Brief Pain Inventory - Short
Form (BPI-SF) (5).
Study Three: This study was a systematic review and
meta-analysis which included six randomized controlled
trials (RCTs) involving a total of 374 patients with acute
muscle injuries. The studies compared PRP injections to
placebo injections or physical therapy. Inclusion criteria
required patients to have acute (≤7 days) grade I or II
muscle strains confirmed by clinical examination and/or
imaging. Exclusion criteria included case series, review
articles, technique descriptions, basic science articles
lacking patient-specific data, and studies with less than
six months of follow-up for reinjury rates. Outcomes
evaluated included time to return to sport, reinjury rates,
complications, pain levels, muscle strength, range of
motion, muscle function, and imaging results (3).
These methodologies aim to provide a thorough
assessment of PRP’s efficacy in treating acute muscle
injuries, drawing from a diverse range of study designs
and populations to offer comprehensive insights into this
emerging therapy in sports medicine.

RESULTS

In the first study, researchers induced injury in rat

models to study the recovery of function in the whole Figure 1. Maximal torque was measured in each animal
ankle dorsiflexor group, focusing on the tibialis anterior before injury (CTL) and immediately after injury (D0).
(TA) muscles, which generate most of the torque in this Adapted from Hammond et al. [2009].

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 Platelet-Rich Plasma for Accelerating Muscle Injury Recovery in Athletes

by 7 to 14 days (Figure 1) (1). sport in the PRP group compared to the control group
The second study involved a randomized controlled (placebo or rehabilitation), with a mean difference (MD)
trial (RCT) with 28 patients suffering from sports-related of -5.57 days (95% CI -9.57 to -1.58; P=0.006). However,
muscle injuries, divided into a control group and a PRP a subgroup analysis focusing solely on acute grade I or II
group. A survival curve illustrated the effect over time for hamstring muscle strains found no significant difference
patients in both intervention groups (Figure 2) (5). in time to return to sport between the PRP and control
This study aimed to evaluate the effectiveness of PRP groups (3 studies, 159 patients; MD -3.92 days [95% CI
injections in reducing recovery time for sports-related -9.73 to 1.89]; P=0.19) (3).
muscle injuries. It was found that 50% of patients receiving Further analysis of studies with higher methodological
PRP treatment achieved complete recovery by week 26 quality also found no significant difference in time to
of the follow-up period, compared to the control group, return to sport between PRP and control therapy (4
which reached the same recovery rate at week 29. The studies, 234 patients; MD -3.28 days [95% CI -6.61 to
average time for athletes to return to play was significantly 0.05]; P=0.05). Additionally, no difference was observed
shorter in the PRP group (26.7 ± 7.0 days) compared to the in return to sport between PRP and control therapy in
control group (42.5 ± 20.6 days). Statistical analysis using studies that included only acute grade II muscle strains
the log-rank (Mantel-Cox) test demonstrated a significant (2 studies, 99 patients; MD 8.21 days [95% CI -19.42 to
difference in recovery patterns between the two groups, 3.00]; P=0.15) (3). The meta-analysis suggests that PRP
further supporting the effectiveness of PRP treatment in injections can significantly reduce the time to return to
accelerating muscle injury recovery (5). sport for patients with grade I or II muscle strains without
The third study, a systematic review and meta-analysis increasing the risk of reinjury at six months follow-up.
involving 374 participants across six eligible studies, However, subsequent subgroup analyses did not show
aimed to compare the time to return to sport and reinjury this benefit for patients with hamstring strains. For most
rates following PRP injection versus control therapy in sports, an earlier return to play by approximately one week
patients with acute grade I or II muscle strains. Results could enable an athlete to participate in 1 to 2 additional
indicated a significant reduction in time to return to games, potentially having a significant clinical impact (3).

DISCUSSION

The variability in results across these studies

highlights the complexity of PRP therapy. While the
first two studies—encompassing both an animal model
and clinical trial—suggest significant benefits, the meta-
analysis points to inconsistencies, particularly within
subgroups with specific types of muscle strains such as
hamstring injuries. These findings suggest that while
PRP therapy may be effective in some cases, its outcomes
could be influenced by factors such as the type of injury,
PRP preparation protocols, and individual patient
characteristics. These discrepancies underscore the
necessity for further research to confirm PRP’s benefits
and optimize treatment protocols. More randomized
controlled trials would be especially valuable, as they are
less likely to be influenced by external factors.
The first study focused on a controlled laboratory
setting with rat models. This study was strengthened
by several methodological advantages. One key benefit
was the use of two distinct in vivo protocols to induce
muscle injury: a 90° arc of plantarflexion for acute strains
Figure 2. Survival functions of the control and platelet- and a 60° arc for repeated strains. This dual approach
rich plasma groups. Adapted from Hamid et al. [2014]. enabled a comprehensive analysis of PRP’s effectiveness

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 Platelet-Rich Plasma for Accelerating Muscle Injury Recovery in Athletes

across different types of muscle injuries. The controlled future research in this area (5).
environment of an animal model allowed for precise Despite these strengths, several limitations exist in this
control over variables such as contraction force, type, study. Variability in PRP preparation methods, injection
and timing, as well as dietary and activity levels. This techniques, and rehabilitation protocols across studies
level of control helped ensure the internal validity of the complicates comparisons and may affect outcomes.
study by minimizing external variables that could affect Additionally, most patients did not record their daily
the results. Furthermore, the study’s use of maximal unsupervised rehabilitation sessions at home, potentially
stimulation to recruit all motor units within the muscle leading to varied results, although they confirmed
ensured consistent injury induction, facilitating reliable adherence during follow-up appointments (5).
comparisons of recovery outcomes (1). The third study, involving 268 patients across five
However, the use of an animal model also has its investigations, presents several notable advantages
limitations. The applicability of animal model results to regarding the use of PRP injections for muscle strain
human conditions remains uncertain, as the controlled recovery. This systematic review, which included five
experimental parameters do not fully represent the randomized trials, most of which exhibited moderate
complexity and variability of human muscle injuries. to excellent methodological quality, provides a
Additionally, the study did not identify which specific comprehensive analysis of the available evidence.
components of PRP were responsible for the observed By employing an extensive search strategy across
improvements in muscle recovery, leaving questions various electronic databases, the researchers ensured
about the optimal formulation and dosage. These gaps that all relevant studies were considered, significantly
highlight the need for further research to determine the enhancing the credibility of their findings. Additionally,
most effective use of PRP in treating muscle injuries, the study addressed heterogeneity in rehabilitation
including the appropriate type of strain injury, optimal protocols and PRP characteristics—such as frequency,
dose, and delivery method, as well as if animal models volume, and manufacturer—crucial factors for
would provide accurate representation (1). understanding the diverse outcomes observed in PRP
In the second study, the use of platelet-rich plasma research. By acknowledging these differences, the
(PRP) injections for accelerating recovery in athletes with study sets the stage for future research to determine
muscle strains has been increasingly researched, with this the optimal PRP composition and application methods
study offering several key advantages in its approach. for muscle injuries (3).
Firstly, it represents one of the first RCTs specifically Nonetheless, this systematic review also had
assessing PRP’s effectiveness for hamstring injuries, limitations. Despite finding a statistically and clinically
providing a higher level of evidence than previous case significant difference in time to return to sport favoring
reports or retrospective studies. The study’s design, PRP, there was substantial heterogeneity among the
focusing on grade 2a hamstring injuries, offers valuable eligible studies. Specifically, heterogeneity in outcome
insights into a common and specific clinical problem, measures prevented further pooled subgroup analyses,
potentially guiding future treatment protocols for this making it difficult to draw definitive conclusions
particular injury type (5). about the effect of PRP on other patient-reported and
Moreover, the study’s methodology includes several physician-derived outcomes such as pain, satisfaction,
strengths that enhance its reliability and applicability. and strength (3).
The use of ultrasound-guided injections makes sure of
accurate PRP delivery to the injured area, improving the CONCLUSION
consistency of treatment. The comprehensive assessment
criteria, combining both subjective pain measures (BPI- The examination of platelet-rich plasma (PRP) therapy
SF) and objective physical and strength assessments for muscle injuries reveals a complex interplay of efficacy,
(Biodex isokinetic machines), provide a robust evaluation methodology, and variability across studies. While initial
of recovery. Additionally, the study’s comparison of PRP- findings indicate that PRP can significantly enhance
treated patients with a control group without the use of recovery, particularly in controlled settings, the differences
concurrent medications allows for a clearer evaluation of noted in larger meta-analyses highlight the need for further
PRP’s specific effects. These methodological advantages investigation. The strengths of the reviewed studies, such
contribute to a more rigorous assessment of PRP’s efficacy as rigorous methodologies and comprehensive assessment
in treating muscle strains, offering a solid foundation for protocols, provide valuable insights into PRP’s potential

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benefits. However, limitations including variability in PRP https://doi.org/10.1177/1941738113480934

preparation, injection techniques, and the applicability of 3. Sheth U, Dwyer T, Smith I, Wasserstein D, Theodoropou-
animal models to human conditions raise critical questions los J, Takhar S, Chahal J. Does Platelet-Rich Plasma Lead
about the generalizability of these findings. to Earlier Return to Sport When Compared With Conser-
Future research should focus on addressing these gaps vative Treatment in Acute Muscle Injuries? A Systematic
by standardizing PRP preparation methods, exploring Review and Meta-analysis. Arthroscopy. 2018 Jan; 34 (1):
the specific components responsible for recovery, and 281-288.e1. https://doi.org/10.1016/j.arthro.2017.06.039
conducting larger randomized controlled trials that include 4. Mueller-Wohlfahrt H, Haensel L, Mithoefer K, et al. Ter-
diverse patient populations and injury types. Additionally, minology and classification of muscle injuries in sport:
investigating optimal dosages and delivery methods could The Munich consensus statementBritish Journal of Sports
refine treatment protocols and enhance clinical outcomes. Medicine 2013; 47: 342-350. https://doi.org/10.1136/bjs-
By systematically addressing these areas, the scientific ports-2012-091448
community can improve the understanding of PRP 5. A Hamid, Mohamad & Ali, Mohamed & Yusof, Ashril &
therapy, ultimately leading to more effective and tailored George, John & Lee, Leena. (2014). Platelet-Rich Plasma
interventions for individuals suffering from muscle Injections for the Treatment of Hamstring Injuries A
strains. All in all, while there is a strong promise for PRP Randomized Controlled Trial. The American journal of
therapy, further and larger studies are required to solidify sports medicine. 2014 Oct; 42 (10): 2410-2418. https://doi.
the role of PRP injections in every day clinical practices. org/10.1177/0363546514541540
6. Kelly S, Pollock N, Polglass G, Clarsen B. Injury and Ill-
FUNDING SOURCES ness in Elite Athletics: A Prospective Cohort Study Over
Three Seasons. IJSPT. 2022; 17 (3): 420-433. https://doi.
The author has no funding sources to disclose. org/10.26603/001c.32589
7. MedlinePlus [Internet]. Bethesda (MD): National Library
DECLARATION OF CONFLICT OF INTERESTS of Medicine (US); [updated Jun 24; cited 2020 Jul 1]. Avail-
able from: https://medlineplus.gov/.
The author(s) declare that there are no conflicts of 8. How platelet-rich plasma therapy can help treat common
interest regarding the publication of this article. orthopaedic injuries. Temple Health.(n.d.). https://www.
templehealth.org/about/blog/how-platelet-rich-plasma-
REFERENCES therapy-can-help-treat-common-orthopaedic-injuries
9. Perishable. (2023, November 27). Orthobiologics: What
1. Hammond JW, Hinton RY, Curl LA, Muriel JM, Lovering do athletes need to know about PRP: USADA. U.S. Anti-
RM. Use of autologous platelet-rich plasma to treat muscle Doping Agency (USADA). https://www.usada.org/spirit-
strain injuries. Am J Sports Med. 2009 Jun; 37 (6): 1135- of-sport/education/orthobiologics-athletes-need-know-prp/
1142. https://doi.org/10.1177/0363546508330974 10. Platelet-rich plasma (PRP) injections. Johns Hopkins
2. Delos D, Maak TG, Rodeo SA. Muscle injuries in athletes: Medicine. (2023, June 9). https://www.hopkinsmedicine.
enhancing recovery through scientific understanding and org/health/treatment-tests-and-therapies/plateletrich-
novel therapies. Sports Health. 2013 Jul; 5 (4): 346-352. plasma-prp-treatment

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