PRP Injections | Dr. Ashok Bhandari, ND

The Science

What Is Platelet-Rich Plasma?

Platelet-rich plasma — PRP — is a concentrated product of the patient's own blood, with higher platelet and growth factor concentrations than whole blood. When injected into damaged tissue, activated platelets release growth factors and cytokines that trigger new tissue growth, restore blood flow, and recruit the body's own stem cells to resolve the cause of pain, instead of masking the symptom.

Platelets are a primary cell type present during the acute phase of an injury, acting as the body's first responders to injury. When activated, the platelets become "sticky," allowing them to attach to the site of injury and initiate clot formation, release growth factors and enzymes, signal and recruit mesenchymal stem cells and fibroblasts (collagen producing cells), and build the scaffolding which will house the environment for tissue healing. PRP can also contain white blood cells and human growth hormone (hGH), among other growth factors, which are vital to promoting and sustaining a local healing response. As a result, the body is able to grow new tissue, thereby healing and strengthening the previously damaged area.

When PRP is injected into a site of damaged or inflamed tissues, the body responds with an acute inflammatory response followed by an anti-inflammatory healing cascade. This process leads to growing stronger new tissues, increasing blood flow to help support healing, regulating inflammation to reduce pain, and signal the recruitment of the body's own stem cells to help with the repair process. As a result, injured tissues truly heal to resolve the cause of pain, instead of simply masking the symptom of pain.

The Process

How Is Platelet-Rich Plasma Prepared?

A simple blood draw to collect the patient's blood, which is then processed in a centrifuge to separate and concentrate the platelets and growth factors. The concentrated platelet-rich plasma is further dosed to the unique needs of the patient and the treatment at hand, then delivered precisely where it is needed most.

Blood Draw

A small volume of blood is drawn from the patient. Depending on the treatment specifics, the volume of blood can vary significantly.

Centrifugation

The blood is processed in a centrifuge to separate out and concentrate the platelets and growth factors. Depending on the specific type of PRP desired, this can include high or low concentrations of white blood cells.

Platelet Dosing

The collected platelet-rich plasma can then further be precisely concentrated and dosed to the unique needs of the patient and the treatment at hand, and can also be further processed into other derivatives of PRP, if needed.

Platelet-rich plasma preparation and lab-verified dosing for PRP therapy at SageMED clinic, Bellevue WA

The Mechanism

How Does PRP Work?

When PRP is injected into damaged or degenerated tissue, the concentrated platelets respond immediately, triggering the release of stored growth factors and cytokines, which initiates a cascade of cellular events that leads to a healing response. This is fundamentally different from untreated chronic injury, where the healing response has stalled or been chronically suppressed.

Chronic tendon, cartilage, and ligament injuries are often characterized not by absence of inflammation, but by a low-grade, non-resolving inflammatory state that degrades tissue faster than it can be rebuilt. PRP introduces a pro-healing environment that helps shift this stalled state toward active repair. Clinical evidence from peer-reviewed literature suggests meaningful benefit across several orthopedic applications, with the strongest evidence base in knee osteoarthritis and chronic tendinopathy.

The type of PRP preparation is also varied to best match the type of injury, the tissue involved, and the ultimate purpose of the treatment. There are leukocyte-rich vs. leukocyte-poor preparations, which vary in concentration of white blood cells and are chosen specifically based on the level of inflammatory response and "aggressiveness" of treatment needed. There are also preparations that involve pre-activating the PRP, breaking down and filtering the platelets prior to injection, and even concentrating the platelet-poor plasma to obtain a protein-rich solution of plasma proteins such as alpha-2 macroglobulin (A2M). Depending on the specific case, Dr. Bhandari uniquely customizes the preparation to best meet the patient's needs.

Educational Video

Understanding Platelet-Rich Plasma Therapy

Coming Soon: Dr. Bhandari Talks about Platelet-Rich Plasma Therapy.

Dr. Bhandari regularly publishes educational content on regenerative injection therapies, including procedure walkthroughs, patient outcome discussions, and clinical insights on the evidence behind each modality. Subscribe to stay current with new content as it's released.

Clinical Applications

Which Conditions Has PRP Shown Clinical Benefit For?

Clinical evidence supports PRP for a wide range of musculoskeletal conditions, including joint osteoarthritis, ligament and tendon injuries, cartilage damage, and more, with the strongest evidence base in knee osteoarthritis and chronic tendinopathy. The conditions listed here represent those most frequently seen in Dr. Bhandari's practice where PRP has demonstrated meaningful clinical benefit.

Joints & Arthritis

Knee osteoarthritis Hip osteoarthritis Foot, ankle, & toe osteoarthritis Hand, wrist, & thumb/finger osteoarthritis Shoulder osteoarthritis Elbow osteoarthritis Spinal facet joint osteoarthritis Sacroiliac joint osteoarthritis

Ligaments

Partial ACL tears Partial MCL/LCL tears Partial PCL tears Ankle sprains and chronic instability Plantar fasciitis and tears Elbow sprains: UCL and RCL tears Spinal ligament tears and laxity Sacroiliac ligament laxity Shoulder ligament sprains and laxity Wrist and hand ligament sprains and tears

Tendons

Rotator cuff tears and tendinopathy Achilles tears and tendinopathy Patellar tears and tendinopathy Tennis elbow/Golfer's elbow tears and tendinopathy Bicipital tendon tears and tendinopathy Peroneal tendon tears and tendinopathy Hamstring tendon tears and tendinopathy

Other

Plantar fasciitis Meniscus injuries Labrum injuries Chronic nerve injuries Muscle tears Post-surgical healing support Joint hypermobility Cartilage injuries Frozen shoulder

Not sure if your condition qualifies? Dr. Bhandari evaluates each patient's case individually. A summary of your history and a thorough physical exam can often be enough to determine whether PRP may be a reasonable consideration for you. Contact us to discuss your specific situation.

The Difference in Approach

Why Does the Quality of PRP Vary Between Providers?

PRP has become popular and widely available, which means quality and protocols vary enormously. Outcomes depend on four controllable variables: whether baseline platelet counts are measured before dosing, whether the preparation is matched to the tissue and injury type, whether delivery is confirmed under ultrasound guidance, and whether a thorough diagnostic assessment has identified the correct structure to treat.

Comprehensive Assessment Before Treatment

Every patient undergoes a thorough clinical evaluation before a treatment plan is proposed: detailed history, physical examination, review of existing and new imaging, and laboratory analysis. An accurate diagnosis of the root cause of pain is crucial to successful treatment. Since pain can be multifactorial and not always due to what is found to be "damaged" on imaging, the specific structures that are generating the pain must be identified. This could be the joint, cartilage, ligaments, fascia, or nerves. Without an accurate diagnosis, even the best treatments may fail to resolve the pain.

Lab-Guided Platelet Dosing

Before treatment, Dr. Bhandari orders a CBC (complete blood count) to establish your individual baseline platelet count. The PRP preparation is then processed and concentrated precisely to target the optimal therapeutic concentration range for your specific biology. It is never a fixed volume based on a standard kit or protocol. Platelet counts vary significantly between individuals; ignoring this variation means ignoring one of the most controllable variables in the protocol.

Imaging-Guided Delivery

Every PRP injection at Dr. Bhandari's office is performed under real-time ultrasound guidance. The needle is visualized as it advances to the target tissue, and the injection is confirmed on-screen before the PRP is injected. Precise location accuracy dramatically improves outcomes while minimizing unnecessary risk, compared to palpation guiding injections (blind injections). Blind injection of PRP, which is unfortunately practiced widely, is a meaningful limitation on treatment effectiveness.

Individualized & Integrated Regenerative Treatments

PRP is not always the first thing Dr. Bhandari reaches for — and it may not be what your case calls for at all. PRP is often most effective as part of a broader regenerative strategy. Depending on what the assessment reveals, Dr. Bhandari may combine PRP with stem cell therapy, perineural injection therapy, prolotherapy, shockwave therapy, or peptide protocols to support systemic recovery.

Companion Therapies

PRP is frequently used in combination with other treatments, depending on the individual clinical picture. PRP is often most effective as part of a broader regenerative strategy, combined with prolotherapy, perineural injection therapy, stem cell therapy, shockwave, or peptide protocols. Comprehensive treatment of an injury provides the best chance at a meaningful positive response.

Common Questions

Frequently Asked Questions

How is PRP different from a cortisone injection?

Cortisone injections are strong anti-inflammatory medicines that suppress the local inflammatory response to reduce pain. This can provide short-term relief, but the use of cortisone can worsen tissue integrity over time by preventing the healing process from completing. Platelet-Rich Plasma works in the opposite manner, and rather than suppressing inflammation, delivers a concentrated dose of the body's own growth factors and platelets to damaged tissue, initiating the acute inflammatory response followed by the anti-inflammatory healing cascade that drives actual tissue repair. The goal is for injured tissues to truly heal and resolve the cause of pain, rather than simply masking the pain.

How many PRP treatments will I need?

This depends on the structure being treated, the severity of tissue damage, and the body's response to the initial treatment. Many patients experience meaningful improvement after a single treatment, while others may benefit from follow up treatments. The specific plan is determined after a thorough assessment of the condition. Dr. Bhandari will discuss what is realistic for your specific case during an initial consultation.

Am I a good candidate for PRP therapy?

PRP is appropriate for a wide range of acute and chronic orthopedic conditions involving joints, tendons, ligaments, and cartilage. Candidacy depends on accurate diagnosis of the source of pain. Because pain can be multifactorial, the structures generating pain must be correctly identified before treatment. A comprehensive assessment that includes a thorough physical examination and imaging review is the starting point. This is best addressed in a conversation with Dr. Bhandari about your history, your imaging, and what options are available to you.

Does PRP involve a painful injection?

PRP is delivered under real-time ultrasound guidance, which allows precise placement into the target structure. A local anesthetic is used at the skin surface to minimize the discomfort of the injection procedure, and Dr. Bhandari takes every step possible to ensure patients are as comfortable during the procedure as possible. The level of discomfort varies depending on the location and depth of the injection, and some patients may feel more pressure or brief pain in more sensitive areas. Some post-procedure soreness in the treated area is normal and expected in the days following treatment. This is a part of the healing response being initiated, and not a sign that something went wrong. Most patients tolerate the treatment well and return to light activity relatively quickly. Any specific concerns about pain or sensitivity are best discussed during the consultation.

When can I expect to see results from PRP?

PRP works by initiating a healing cascade, instead of masking pain, so results develop gradually as tissue repair progresses. Many patients begin to notice improvement in the weeks following treatment, with continued improvement over subsequent months. Peak benefit for most orthobiologic therapies is typically observed within three to six months. Dr. Bhandari strives to set realistic expectations for your specific case at your initial consultation.

Take the Next Step

Ready to Explore PRP Therapy?

Schedule a consultation with Dr. Bhandari to determine whether PRP is appropriate for your specific condition, and if so, exactly how he would approach your case. Every treatment plan begins with a thorough individual assessment, instead of a "plug-and-play" protocol.

Book a Consultation Ask Dr. Bhandari