Is Platelet-Rich Plasma Therapy a Friend to MMA?

Finding reliable treatments for injuries can be difficult in sports, especially mixed martial arts. Surgery can become an inevitability, but once touched by a surgeon’s knife, the human body is sometimes never the same. Yet there may be hope for combat-sports athletes trying to dodge surgeries, heal nagging injuries and avoid fight cancellations. That hope may come in the form of platelet-rich plasma treatment.

MMA can be brutal on an athlete’s body. From its violence inside the cage to the daily grind of a training camp, injuries eventually pile up. As a result, careers are sidetracked and fighters are often forced to drop out at the last minute, much to the dismay of promoters and fans. To avoid or mitigate injuries, fighters and their trainers try all manner of treatments: massage therapists, chiropractors, ice baths, cryotherapy, hydrotherapy, assigned diets, electrical muscle stimulation and even naps. In the last few years, PRP has joined a litany of treatments as fighters seek to repair debilitating injuries in an affordable and healthy way.

PRP entered the sports-fan lexicon in 2013, when NBA great Kobe Bryant used Regenokine treatment to improve his knee arthritis. Bryant’s decision seemed that of a desperate player realizing his sporting mortality after averaging just 13 points per game -- the second-lowest mark of his career -- during an injury-shortened 2013-14 season. However, when he returned the next year, the 36-year-old averaged 22 points per game and was awarded a spot on the Western Conference all-star team.

From that moment on, the sports world was put on notice regarding these new options to treat physical ailments. However, while similar, Regenokine is different from traditional PRP treatment. Why? Because substances are added to the healing mix being injected into patients. In contrast, traditional PRP does not add anything the body did not already include. As a result, PRP remains a legal treatment option for professional athletes in the United States. Some of the biggest names in professional sports have sought out this therapy. For example, NBA stars Isaiah Thomas (groin) and Stephen Curry (knee), and MLB pitchers Garrett Richards (elbow) and Stephen Strasburg (elbow) have undergone PRP treatment in recent years. The stars of MMA are no different.

Southern Florida’s NovaGenix clinic has specialized in PRP treatment for years, working with fighters and trainers from nearby powerhouse gyms like American Top Team and Hard Knocks 365. As co-founder Tim Bruce explained on a recent episode of the Fight Strength Podcast, PRP treatments consist of drawing 50 cubic centimeters of a patient’s blood and mixing it with an anti-coagulant. The mix is then put into a centrifuge where it is spun. The goal is to separate the platelets from the blood/anti-coagulant mix. Platelets secrete cytokines, or growth factors, and those cytokines help to draw in cells that are used to heal an injury. Once separated, what is left is about eight CCs of a platelet-rich yellowy substance.

The eight CCs are spun once again, leaving as much as eight billion platelets, which can be 10 times more than a normal blood sample. This substance of platelet-rich plasma is then injected into an injured area. This sticky, yellowy mix will cling to the cell receptors and aid in healing the body on a much greater scale than it would have under normal healing. Bruce estimates that as many as 50 percent of NovaGenix’s patients are combat-sports athletes. Some of the clinic’s recent work has reportedly helped a few Ultimate Fighting Championship competitors avoid injury cancellations of their bouts. In the weeks leading up to his UFC 222 fight with Sean O'Malley, Andre Soukhamthath ruptured his MCL after accidental contact during practice. The injury was severe enough that being removed from the event seemed like a real possibility. However, on the advice of his trainers, Soukhamthath visited NovaGenix for some PRP treatment. After waiting the prescribed 72 hours to let the platelet-rich plasma work its way into his knee, the bantamweight restarted his training and competed at the event. Since he managed to fight, he earned his $19,000 “show money” and banked an extra $50,000 “Fight of the Night” bonus.

“He told me,” Bruce said, “bro, if it wasn’t for the PRP, I would not have been able to get through and finish camp and take that fight.”

Volkan Oezdemir also visited the clinic in the lead up to the biggest fight of his career. Before he was set to fight for the UFC light heavyweight title against Daniel Cormier, the Swiss fighter incurred an injury in his power hand -- something that would have surely hindered the knockout artist’s chance for success. However, after one PRP treatment, he indicated he could continue training and fight with his worries eased.

“These guys can’t be injured,” Bruce said. “If they’re not training, they have some serious problems.”

While the science of PRP has pushed many in the medical field to try it for various ailments, it is apparently not a magic cure for all physical problems human beings encounter. When it comes to major injuries, sometimes surgery is the only answer.

“If you have a total tear, is it going to cure you? No, it’s not going to fix everything,” Bruce admitted.

While Bruce believes the treatment is extremely effective in treating many physical maladies, he suggests some are not providing the treatment correctly.

“There’s no real standardized method that you’ll see out there,” he said. “People are using techniques that are yielding much lower harvests of viable cells.”

The inconsistent results among PRP providers have consequences. Bruce believes it is the reason the treatment is still viewed by many as experimental and not covered by most health insurance plans. Bruce indicates negative results can occur from something as simple as the incorrect use of anti-coagulants. Even the wrong angles of test tubes used in centrifuge can damage the cells harvested from blood samples.

“When you do PRP the right way, it is very effective,” Bruce said.

Still, one shot does not always do the trick. American Top Team strength-and-conditioning coach and bodybuilding competitor Phil Daru serves as an example.

“I’ve had tendinitis in my knees due to high amounts of squatting, with high intensities and loads,” said Daru, who took an injection of PRP to improve the joint discomfort. “I did one injection and if felt good for a little bit, and I came back [two weeks later] and did another.”

Since then, the issues with his knees have improved greatly. The results have led him to suggest PRP injections for fighters he trains at ATT, combatants like Valerie Letourneau, Muhammed Lawal and Jessica Aguilar. One Championship fighter Herbert Burns has also been a frequent PRP user. The 6-2 featherweight has received injections at least “10 times” over the years, often because he believed the first treatment was insufficient.

“The times that I did it [the injection], it did not get completely healed,” Burns said. “It got better, around 60 percent, then I did it again, and it was completely healed.”

While not a total fix the first time, follow-ups have helped the fighter heal nagging injuries. When asked if it helped him avoid going under a surgeon’s knife, Burns was quick to answer.

“Yes, for sure, in different parts of my body,” he said.

What makes PRP such an intriguing option for professional athletes is the nature of the treatment. PRP is a procedure that is not invasive like surgery, which can keep professional athletes on the sidelines for weeks or months at a time. PRP treatment has reportedly shown marked improvement in injuries as quickly as 10 days after injection. UFC featherweight Chas Skelly -- who also goes to NovaGenix -- has seen this quick improvement firsthand. After receiving an injection in his shoulder, which he admits felt fully healthy two weeks later, Skelly then had a PRP injection in his knee.

“I later got a shot in my knee, because I had a sprained MCL,” he said. “I took the proper amount of rest, and my knee felt great in about 10 days. I haven’t had any problems with my knee since.”

Daru, Burns and Skelly reported that they have yet to encounter fellow fighters who have not benefited from PRP treatment. In an era in which the United States Anti-Doping Agency oversees testing for a major promotion like the UFC, fighters are understandably wary of a procedure that is not covered by most insurance companies. Remember, fighters are being popped for tainted meat nowadays. In an email exchange Bruce had with Adam BeHarry, the athlete biological passport manager for USADA, some clarity was brought to the issue. When asked if PRP is prohibited by the doping agency, BeHarry stated it is not banned by USADA but added a caveat: “We cannot 100 percent approve PRP since PRP therapy is prohibited if it offers performance-enhancing effects, or if the PRP was altered in a way that can produce performance-enhancing benefits. Thus, the only use of PRP therapy should be the restoration of pre-injury level of function.”

For clinics like NovaGenix that only use a patient’s blood sample and anti-coagulants in their mix, a normal PRP treatment can help fighters restore body parts to pre-injury levels while keeping them away from the dangers of suspension; and if fighters can avoid bout cancellations and stretch out their careers, promotions -- and the fans that follow them -- get their money’s worth much more often.

MMA is undeniably harsh on the body. Even training for a fight can be more damaging than many other sports at maximum effort. Fighters going into fights at less than 100 percent is an expected facet of the game. As such, any safe and legal treatment that might help injuries and reduce surgeries should be considered. Advocates of PRP do not claim it to be a miracle cure for all injuries. In fact, some researchers have suggested that variability in study design have led to inconsistent outcomes. However, other researchers have found promising results. For fighters or coaches who must work with or around injuries, some of the research is compelling and may be worth further investigation.

An expert in leadership and human performance, Dr. Paul “Paulie Gloves” Gavoni is a highly successful professional striking coach in mixed martial arts. As an athletic leader and former Golden Gloves heavyweight champion in Florida, he successfully applies the science of human behavior to coach multiple fighters to championship titles at varying levels worldwide. With many successful fighters on his resume, he tailors his approach to fit the needs of specific fighters based on a fighter’s behavioral, physiological and psychological characteristics. Gavoni is a featured coach in the book, “Beast: Blood, Struggle, and Dreams at the Heart of Mixed Martial Arts” and the Bloody Elbow article “Ring to Cage: How Four Former Boxers Help Mold MMA’s Finest. He can be reached at [email protected].

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