Injections

Good Morning! What a weekend of college football with Bama and Texas both going down. Speaking of Bama’s loss to Florida State this weekend, I recently just got hired as a Physical Therapy Intern for the season for Florida State! I start on the 8th and will be with the football team for the season. Go Noles!

Today, I will be talking about PRP and PPP injections.

When athletes deal with nagging injuries that just don’t seem to heal, they often look beyond standard rest, ice, and rehab. In recent years, two biologic injection treatments—platelet-rich plasma (PRP) and platelet-poor plasma (PPP)—have been popular in sports medicine. Both treatments come from your own blood, both are considered regenerative therapies, and both are used to help with soft tissue and joint problems. But they aren’t the same, and understanding the difference is key as a clinician and a patient.

Both PRP and PPP start with a simple blood draw, typically around 30 to 60 milliliters. That blood is spun in a centrifuge to separate it into layers based on density. The bottom layer is red blood cells, the middle is platelet-rich plasma, and the top layer is platelet-poor plasma. Depending on the treatment goals, your provider may extract only PRP, only PPP, or sometimes use both together.

PRP has received the most attention because it contains a high concentration of platelets. These platelets aren’t just important for clotting—they’re packed with growth factors and bioactive proteins that help the body repair tissue, reduce inflammation, and stimulate healing. Delivering PRP to an injured area essentially gives your body a targeted boost, speeding up processes that normally happen slowly in tissues with limited blood supply, such as tendons and cartilage. That’s why PRP has become a go-to treatment for conditions like tennis elbow, jumper’s knee, partial ligament tears, and even early-stage arthritis. It’s also sometimes used after surgery to promote faster tissue repair.

PPP, on the other hand, contains fewer platelets and therefore fewer growth factors. Even without as many platelets, PPP contains plasma proteins like albumin and fibrinogen that influence inflammation and support healing. Some studies suggest that PPP can act as a natural lubricant for joints, helping with pain reduction and cartilage support. While it might not trigger regeneration as strongly as PRP, it can improve the environment for healing, reduce swelling, and possibly offer longer-lasting relief for people with inflammatory joint issues.

The evidence supporting these injections is growing, though it is still mixed. PRP has by far the stronger track record, with dozens of studies showing benefits in treating conditions like tennis elbow, partial tendon injuries, and mild to moderate arthritis. Many patients experience reduced pain and improved function compared to those who receive cortisone or hyaluronic acid injections. PPP, while not as well studied, has shown promise for reducing pain and inflammation in arthritis patients, with some theories suggesting that it works more as a cushion than a stimulant. One important takeaway is that individual response matters; some athletes respond extremely well to PRP, while others notice little change, and PPP may be better suited for certain people depending on the nature of their condition.

When comparing these injections to more traditional treatments, the differences are worth noting. Cortisone shots are excellent for short-term pain relief but can slow long-term healing and may even weaken tissue with repeated use. Hyaluronic acid injections—sometimes called “gel shots”—help lubricate joints but don’t do much to actually repair damage. PRP and PPP, by contrast, aim to address the healing environment itself, not just the symptoms. Think of cortisone as silencing the fire alarm, hyaluronic acid as greasing the hinges, and PRP or PPP as working on fixing the broken parts.

Ultimately, the decision to use PRP or PPP depends on the injury, the goals, and the budget. PRP is the more aggressive option, offering a higher concentration of growth factors to stimulate repair in tendons, ligaments, and cartilage. The return to play takes longer, however there is more prevention of reinjury. PPP is more subtle, reducing inflammation and improving joint lubrication, and may be a better fit for certain chronic or inflammatory conditions. PPP results in less time for return to play with less prevention of reinjury. Neither treatment is a magic bullet. They work best as part of a comprehensive plan that includes physical therapy, strength and mobility training, and careful load management.