The other day I 
mentioned that I suspected Rafa Nadal had undergone PRP treatment for chronic knee tendinitis. My reasons for being suspicious are that:
- PRP is one of the latest treatment methods for tendinitis
- I’m fairly sure Rafa would have tried everything else
- I noticed before Monte Carlo Rafa was wearing a strange little band aid patch like what people have put on post-scope except it was over his muscle (see video)
- He has had a noticeable mark on his right knee near the patella tendon (see photo.)
- Rafa talked about a ‘new treatment’ that had led to a vast improvement in his symptoms that he needed to have three times.
- Rafa’s specialist Angel Ruiz Cotorro says the treatment he will have straight after Wimbledon is to “improve the regeneration of the tendon.”
Enter PRP.
So what is PRP? Platelet Rich Plasma. A certain amount of plasma is extracted from your own blood and then separated and injected into the tendon in the same treatment session.
How PRP works is that it helps inhibit excess inflammation so that rehabilitation and activity can be resumed and symptoms improve. It also stimulates the release of growth factors that helps generate more cells while recruiting other cells that aid tissue repair. Growth factors contain cells that assist will healing and tendon regeneration by better simulating the initial healing response. These factors basically help the tendon repair, allowing you to maximize your body’s healing response.
Now as far as I know, and as far as been has revealed to the public, Rafa has chronic knee tendinitis not tendinosis. PRP can also be used to treat tendinosis which is basically an accumulation of repeated injuries to the tendon that have failed to heal properly. A tendinosis is essentially a chronic cycle of poor healing in the absence of inflammation, whereas tendinitis is inflammation to the tendon caused mostly by overload.
How does PRP work in the real world? It’s hard to say. I have only treated one patient who had the injection after 2 years of tendinitis in both hamstrings. Initially the side she had treated with the PRP was worse but after a few months she seems to now be making some steady progress on both sides. I couldn’t say I believe that it was the PRP because both sides are improving, and I know James Blake had the treatment and it didn’t really help (although he also refused to take anti inflammatory medication before trying PRP). It’s not a common place treatment but if I was Rafa I’d do it – can’t make it any worse than having to skip the chance to be defending champion at Wimbledon.
Unfortunately this treatment doesn’t mean we can just breathe a sigh of relief because our favourite Spaniard will be healed. He will still be prone to having issues with his knees because of his style of play and the demands of tennis – both of which I can’t see changing in the foreseeable future. However it should mean he has less injuries, recovers faster and does less damage with each episode. There is currently not a lot of long term research about the effects of PRP on tendinitis however, it has been used for some years in surgery to assist wound healing.
As Rafa stated in his post match interview the recovery from PRP injection (if that is indeed what he has had) does take some time (it can be quite painful from what my patient tells me and from what I head along the grape vine). Nadal will skip Davis Cup in favour of his injections once Wimbledon has finished.
My issue with point 4 of my theory is that Rafa could have slipped and got this mark (although it was originally white and has not become dark) and lately a lot of his tendinitis has been above the patella but it’s part of my theory…. I’d love to hear your theories.
To see previously written information on tendinitis and it’s effect on players click on What happened to Rafa Nadal and Gilles Simon’s knees?
>Prolozone therapy (a variety of prolotherapy, as is PRP) seems to be repairing my meniscus tear and regenerating the surrounding tendons/ligaments–my whole knee feels "tighter" and more stable. I'll be adding PRP to my prolozone treatment this month (my 6th treatment, once each month) as I near the end of my series of treatments just to throw in some more healing power into my knee. I found my local doctor from a list, by city and state, at getprolo.com.
I’m pretty surprised the author dismisses the idea that Nadal has tendinosis rather than tendinitis. Forgive me if I am incorrect, but intuitively I do not see how PRP therapy could be that effective against a purely inflammatory process. After all, the idea of PRP is to stimulate the regeneration and healing of damged tissue, which is exactly the nature of a tendinosis injury. From what I understand, tendinitis on its own has been shown to be extremely rare, and any inflammatory aspect normally goes hand in hand with an underlying degeneration of the tendon caused by repetitive overloading. I would like to see the public release that specifies he has tendinitis and not tendinosis.
Well normally in a case like Nadal’s where it is more chronic it would be more a tendinosis as you say but Nadal’s scans revealed some active inflammation and his team called it tendinitis and seeing we’re not in the physio room with them we can only go with the information we’re given…. But yes PRP works on tendon regeneration and repairing the damage in the tendon that results from tendinitis (more chronic) and tendinosis.
Both tendinopathies can be treated with PRP
What would have been more correct would be ‘tendinopathy’ because we, as observers, can’t tell if there are inflammatory cells or not as the ‘itis’ implies.
Tendinitis is the term most people are familiar with (and frequently call a tendinosis a tendinitis) and as I said in the article “as far as I know, and as far as been has revealed to the public, Rafa has chronic knee tendinitis not tendinosis”. I can’t see how how he doesn’t have both but I have to go with what they release.
His repeated episodes of inflammation have been well documented.