Blood-spinning, in use since the 1980s, increasingly available on the NHS
Tottenham Hotspur’s Gareth Bale used the treatment on his ankle injury
When Tottenham Hotspur’s star Gareth Bale suffered an ankle injury earlier this month, he turned to a controversial blood-spinning treatment to get himself back on his feet.
This high-speed spin causes the blood to separate into its various components. Specifically, it allows platelets (the parts of blood that promote clotting and assist the healing process) and plasma (the liquid part of blood in which red and white blood cells are suspended) to separate from other components in the blood.
By removing the other components, it means the concentration of platelets in the plasma is up to five times higher than normal. Known as Platelet-Rich Plasma (PRP), it contains large amounts of natural growth factors — substances the body uses to heal tissue.
The patient’s PRP is then immediately injected back into the injured area of the body — in Bale’s case, his right ankle. The idea is that it jump-starts recovery, reducing pain and making the injury heal up to five times faster.
This quick and easy treatment has been shown to work for a range of ailments, from arthritic joints to foot pain, and it is increasingly being used within the NHS.
So should you try blood spinning for your creaky knees and old sporting injuries?
Dr Ralph Rogers, a private doctor specialising in sports and orthopaedic medicine at London’s Lister Hospital, believes the treatment holds genuine benefits. ‘Within our blood, we have cells that begin the healing process,’ says Dr Rogers, who has been using the PRP technique for four years. ‘When you injure yourself, the body’s first response is inflammation. This sends platelets to the site of injury, which kick-starts the body to repair itself.’
Drama: Gareth Bale during the Europa League match, when he injured his ankle. He is hoping that it will heal five times faster than normal with the treatment
The ‘super-shot’ of platelets boosts this healing mechanism, he explains, so recovery is faster.
Furthermore, this high concentration of platelets seems to enhance healing so that the body produces less scar tissue.
Blood spinning — or, as it is technically known, Platelet-Rich Plasma Therapy — has been around since the Eighties, when it was first used following open heart surgery to avoid giving excessive amounts of donated blood products, which could contain disease or trigger an immune reaction.
Since then, it has been used in orthopaedics to ease arthritic joints and painful knees, in neurosurgery, wound healing, ear, nose and throat surgery, and face and head surgery. It has even been used in cosmetic treatments, in a procedure called the Vampire FaceLift, which involves injecting a form of PRP into areas of the face to rejuvenate the skin.
Earlier this year, the government body NICE (the National Institute for health and Care Excellence) issued new guidelines acknowledging PRP as a treatment for tendon injuries, common in the elbow, knee and ankle, and plantar fasciitis — inflammation of the band of tissue that stretches from the heel to the middle of the foot.
This common condition affects around one in ten people at some point in their lives and can be triggered by long periods walking or standing, walking in flat shoes, over-exercising or obesity. Dr Rogers explains that the treatment seems particularly effective at treating tendons, which are notoriously difficult to heal due to their poor blood supply.
Over recent years, the PRP treatment has started to grow in popularity, especially for sports injuries, and is now available on the NHS for orthopaedic problems such as tennis and golfer’s elbow, shoulder injuries and Achilles problems, and privately at around £2,000 for three treatments.
Two or more injections may be needed, between four and six weeks apart, depending on the injury.
For best results, Dr Rogers says that physiotherapy should be performed alongside the treatment.
As yet, it is available in only around a dozen places on the NHS, and there are no figures on how frequently it is used. The slow uptake may be due to the fact that the technique has been mired in controversy, with some experts arguing there is still little proof that it works.
Indeed, while NICE says the treatment raises ‘no major safety concerns’, it adds: ‘The evidence on efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.’
Mark Batt, professor of sport and exercise medicine at Nottingham University Hospitals, agrees that more evidence is needed before we can start routinely offering blood spinning to patients. ‘There may be some benefit in the use of these types of injections in the healing process,’ he says.
‘However, it is very difficult to find strong, coherent evidence that it works.’
A study of people with injured Achilles tendons — the fibrous tissue that connects the calf to the heel bone — published in The Journal of the American Medical Association in 2010 found that PRP injections were no more effective than saltwater.
Yet some of the world’s top sports stars, including footballer Jermain Defoe and golfer Tiger Woods, have used the PRP treatment for their injuries, and small studies show promising results.
Blood supply: The technique, available on the NHS, is particularly effective for healing tendons which have limited blood reaching them
One study of 15 patients with elbow pain published in the American Journal of Sports Medicine found that 60 per cent had improved symptoms after eight weeks, and 81 per cent at six months. There were no adverse effects or complications.
Dr Rogers says the UK has been slow to adopt the procedure compared with the U.S. and Europe. ‘The English sports medicine community has frowned upon this technique, with many doctors thinking it doesn’t work. As a result, the British have been latecomers to the technique. While it is true there is still much to learn about this treatment, in general PRP theoretically makes sense: it is the body healing itself.’
In Gareth Bale’s case, Spurs doctors hope PRP will do the trick. With treatment, it is hoped he will miss only a handful of games, and that the forward will soon be back to his top goal-scoring form.