We use PRP (platelet-rich plasma) injections to treat musculoskeletal conditions such as arthritis and tendonitis. As PRP is derived from your blood, we can optimise its efficacy by following a few simple steps before the procedure. Likewise, your post-injection activities could also help recovery. PRP recovery time: what could we do to ensure platelet-rich plasma works better?  

What is Platelet-rich Plasma?

PRP injections

PRP is a blood sample with a higher platelet concentration. We obtain PRP from whole blood from your arm. Blood is centrifuged so that the heavier white and red blood cells sediment to the bottom. The upper portion of the sample contains plasma with a higher platelet concentration. These platelet cells contain high concentrations of growth factors and anti-inflammatory substances that help reduce pain and improve function in tendon and joint pathology. 

PRP injections are an in-office procedure that takes about 45 minutes to complete. Generally, ultrasound is used to guide these injections into a joint or tendon. 

Evidence for PRP Injections

We have evidence supporting PRP injections for select musculoskeletal conditions, but not for all joint or tendon pathology.

The science of PRP is evolving rapidly, so I will keep the evidence up to date. Nevertheless, PRP seems effective for the following musculoskeletal conditions:

  • Knee arthritis: We have 23 RCT trials showing PRP is better than placebo or other injections, such as cortisone or hyaluronic acid. However, we have yet to determine the optimal PPR concentration or the number of injections required for optimal efficacy.
  • Hip arthritis: A recent review found that PRP was more effective than cortisone and other injectables in reducing pain and improving function. In this study, a single injection proved more effective than multiple injections.
  • Tennis elbow: A review of studies shows benefits compared to cortisone or placebo, but not all studies are positive. Overall, PRP is a valuable addition for stubborn tennis elbow.
  • Plantar fasciitis: Nine RCTs show that PRP is better than cortisone for heel spurs or plantar fasciitis. PRP may benefit patients with plantar fasciitis who have failed other treatments, such as physiotherapy, insoles, and shockwave therapy. Moreover, we think PRP is a better and less harmful choice than cortisone.
  • Rotator cuff tendonitis. A few studies have shown that PRP is more effective than corticosteroids for rotator cuff tendonitis at 6-12 months.
  • Achilles tendon partial tears. Although evidence of PRP effectiveness in Achilles tendonitis is limited, we use PRP injections for partial or interstitial tears.

PRP has shown no benefit for joint arthritis in the thumb, fingers, shoulder or ankle. Moreover, no benefit of PRP has been demonstrated for ankle, foot, and patellar tendonitis.

Risks of PRP injections

The risks of PRP are low because we use your blood to obtain the plasma and don’t add anything to it.

Common side effects include:

  • Soreness or pain after the injections. Generally, post-injection pain lasts for a few days. Tendon injections are often more painful than joint injections.
  • Infection. Like any injection, infection is possible. However, we think PRP is less likely to cause infection as your blood has natural antibiotic properties.
  • Tendon rupture. Injecting into a tendon can increase the risk of tendon rupture. However, unlike cortisone, which weakens tendons, PRP does not negatively affect tendon structure. Nonetheless, tendon injections are unpredictable; tendon rupture remains possible.

PRP injection recovery time: what should you do before and after PRP

What we do before and after a PRP injection will significantly affect the outcome. So, you must follow these simple steps to get the most out of this treatment.

How should you prepare for PRP?

We suggest the following simple instructions before your procedure to optimise the PRP effect:

  • Hydrate well on the morning of the procedure. We recommend consuming 1.5 L of fluid a few hours before your injection appointment.
  • Avoid NSAIDs or Aspirin for at least ten days before the procedure. These medications affect platelet function and reduce the body’s natural healing response. Consult your doctor if you are taking Aspirin for blood thinning or heart-related reasons.
  • Reduce or discontinue caffeine intake for 24-48 hours before the injection.
  • Inform your doctor about any medications or supplements, as some may need to be temporarily discontinued.

PRP injection recovery time: what should you do after an injection?

After the PRP injection, you should follow a strict post-injection protocol to optimise the natural healing effect of PRP. These post-injection guidelines include:

  • After PRP injection, the injected area should be rested for a specified period, depending on the location and the condition being treated.
  • Pain management. You could experience short-term pain after a joint or tendon injection. Generally, joint injection soreness lasts a few days, whereas a tendon injection may last up to 7 days longer. Pain-relieving techniques include applying ice to the injected area for 15 minutes every 4 hours to reduce swelling. Additionally, over-the-counter or prescription analgesics (e.g., paracetamol, Co-Codamol, and Co-Dydramol) may be required for the first 24-48 hours after an injection.
  • Avoid NSAIDs such as ibuprofen or Aspirin for at least two weeks after a PRP injection.

How long should you rest after the PRP injection? 

For a lower-body joint injection, you should rest the joint for 2 days. It would be best if you kept your walking distance to a minimum. After three days, you may resume swimming and upper-body weights. After a week, you may resume light walking and non-impact activities, such as yoga. Lighter lower-body weights and cross-training may be initiated after two weeks. After three weeks, you may reengage in running and heavier lower-body weights, depending on the severity of your joint pathology.

For tendon injections, you may need a lengthier recovery. You may require a CAM walker boot for 7-10 days for some tendons, such as the Achilles. In general, rest your tendon for 3 days. Swimming without kicking is allowed after day three. After ten days, restart walking. After two weeks, you may resume cross-training and physiotherapy exercises. Return to running will be guided by your physician and physiotherapist and will depend on your strength and tolerance for tendon-loading exercises.

An example of a PRP injection recovery time for tennis elbow: 

  • Day 0-2: Rest the elbow for two days. Apply regular ice and take simple analgesia for pain.
  • Day 3-7: Reengage with lower body activities, including gym, cycling and running.
  • Day 8-14: Restart exercises targeting tennis elbow. Review by a physiotherapist after ten days.
  • Day 14 -28: Progress with tendon loading exercises and reengage with lighter upper body weights.
  • Day 28 onwards: Resume heavier upper body weights and progress as directed by your therapist.

An example of a PRP injeciton recovery time for a partial tear of the Achilles tendon: 

  • Day 0-10: Rest the Achilles in a short walking boot. On day 2, resume upper body weights. On day 5, reengage with swimming without kicking.
  • Day 11-24: Commence seated calf raises exercises from the floor using a TheraBand or seated calf raise machine 3xweekly.
  • Day 24-42: Commence standing single-leg calf raises from the floor and continue seated leg calf raises 3x weekly. Consult your physician regarding progression, including the addition of weighted isometric holds. Continue cycling and walking.
  • Day 42 onwards: Commence a graded running programme.

Example of PRP injection recovery time for plantar fasciitis

  • Day 0-7: Rest your foot in a short walking boot. Resume upper body weights on day 2. Reengage with swimming on day 3.
  • Day 7-14: Wear a supportive training shoe for gentle walking. Continue upper body weights and swimming. Start foot intrinsic strengthening exercises.
  • Day 14-21: Start cycling and increase walking (10-15 minutes daily). Commence seated calf raises from floor level using therabands or seated calf raise machine 3x/week.
  • Day 21-28: Add standing weighted calf raises to seated calf raises. Continue cycling, swimming, and walking at a faster pace (for more than 20 minutes).
  • Day 28-42: Start progressive walk/run program.

Example of PRP injection recovery time for knee arthritis:

  • Day 0-2: Rest the knee for two days.
  • Day 3-7: Resume upper body weights and swimming.
  • Day 7-14: Return to walking, cycling and cross-training. Resume lighter, lower body weights.
  • Day 14-21: Reengage in heavier lower leg weights.
  • Day 23 onwards: Return to brisk walking and running.

An Example of PRP injeciton recovery time for hamstring tendonitis 

  • Day 0-7: Rest the lower body for 7 days. Resume upper body weights on day 2. 
  • Day 7-14: Resume low-level cycling, cross-training and walking
  • Day 14-21: Return to strength training 
  • Day 21 onwards: Return to the walk/run programme 
man holding knee hoping for PRP injection treatment for arthritis

How soon can I walk after a PRP injection?  

You may begin walking the next day for upper-body tendon and joint injections. We recommend a week of rest from walking after a PRP injection for lower-body joint injections. Generally, lower-limb tendon injections require a more extended recovery period; therefore, we recommend walking after 10 days.

Other Frequently Asked Questions about PRP Injection Recovery Time

Is a higher concentration or platelet count better? 

Some physicians report that a higher platelet concentration or dose is more effective than a lower one. However, the evidence for greater effectiveness is contentious. 

A recent study looking at the effectiveness of PRP in knee arthritis found that a PRP system using an average platelet count of 5 billion did better than systems that used a count of 2.5 billion. A recent review found that PRP systems that used a higher platelet concentration (of at least 4x blood) did better than low concentration systems. 

Two to three standard PRP injections, or one super-concentrated PRP injection, can deliver higher platelet doses and concentrations. An example of a super-concentrated PRP system is Arthrex ACP Max.  

A physician on YouTube stated that a platelet count of 10 billion is the optimal dose for osteoarthritis. Is this true? 

No. This view is based on a 2021 study and is fundamentally flawed. 

Another study published in 2024 showed that a single higher-dose platelet infusion of approximately 5 billion was superior to 2.5 billion. 

Other studies show the opposite: higher platelet doses lead to less effective outcomes for pain and function.

We don’t know the optimal platelet count for knee arthritis, but clinicians should aim for a platelet dose of approximately 5 billion. This dose can be achieved with one or multiple doses. Arthrex ACP Max is an example of a one-shot super-concentrated PRP. 

Can I drive after a PRP injection?

We recommend that you avoid driving immediately after an upper- or lower-body PRP injection. However, you should be able to drive the following day.

Why no alcohol after PRP injection? 

Increased levels of alcohol are associated with decreased platelet activation. So, we recommend you avoid alcohol for two days before and up to three days after a PRP injection.

Do certain prescriptive medications affect PRP? 

Yes. We know that NSAIDs have a direct effect on reducing platelet activation. You should avoid NSAIDs and Aspirin for ten days before and two weeks after a PRP injection.

Do you need to stop caffeine before a PRP injection? 

We know that caffeine reduces platelet activation. Therefore, we recommend avoiding caffeine for two days before and two days after a PRP injection.

How long does PRP take to work?

PRP works by stimulating platelets to release growth factors and anti-inflammatory substances. These chemicals attract reparative substances and cells to the injured area, thereby triggering an inflammatory response. This is why we experience soreness or pain after the procedure. After the inflammatory response, the injured area heals. After a PRP injeciton, we often experience worsening symptoms for a few weeks before the wounded area improves. For joints, we see a positive effect after four weeks. Tendon injuries typically take 6-8 weeks.

Final word from sportdoctorlondon regarding PRP injection recovery time

You can take simple steps before and after PRP injections to enhance the procedure’s effectiveness. Post-PRP injection recovery is typically faster in joint arthritis than in tendonitis. 

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