Hip pain

Treating IT Band syndrome with Platelet Rich Plasma Injections

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Marc Darrow MD,JD

Knee pain is one of the most common problems we see at our institute. When it comes to a more active individual, there can be many knee pain causes. One possible cause is Iliotibial band syndrome or more often referred to as IT band syndrome. It is also commonly referred to by patients as “pain on the outside of my knee.” The people I see with this problem are usually long distance runners and those who are starting up a very aggressive exercise routine and they overdo it.

The pain of IT band syndrome is very familiar to those who have it and those who treat it. It is usually located not only on the outside of the knee but on the length of the the outer thigh from hip to knee. What causes this pain? As just mentioned, overuse injury especially in distance running and over doing it when you start a new exercise program. As you bend your knee, the IT band at its attachment at the shin bone can impinge or trap soft tissue beneath it causing pain. The friction of rubbing against this soft tissue can also thin out and wear away at the Iliotibial band itself.

So what do you do if you have IT band syndrome?

Your doctor may have already recommended to you that you:

  • limit or stop running,
  • ice it at 20 minute intervals,
  • take recommended amounts of anti-inflammatory medications,
  • get some type of brace or kineotape,
  • massage therapy or foam rollers may help,
  • get physical therapy and stretching guidelines.

If all this does not work then you may get a recommendation for a cortisone injection. If the cortisone does not help. You may be told to consider a surgery.

Surgery and conservative care for IT band syndrome

An August 2020 study (1) tried to compare conservative treatments to surgical treatments for IT Band syndrome. Because of limited comparison studies an overall outcome recommendation could not be given. However, the researchers said that the most important finding of their study was that, at short-term follow-up time, conservative therapy for distal IT Band syndrome appeared to reduce pain, and surgical therapy (open, arthroscopic) was effective in returning the athletes to their sport. But, there was severe literature inconsistency and low quality of evidence on the outcomes following both the nonoperative and operative management of IT Band syndrome in active individuals, including non-running athletes. That is why they could not make a firm recommendation. In essence the researchers noted that treatment of IT Band Syndrome was mostly empirical and dependent on the doctor or surgeon seeing the patient. If you decided to go to surgeon, it is likely that you will be prescribed the conservative care options above until they did not work, then you would be recommended to the surgery.

According to the researchers, the principles of surgical management for distal IT Band syndrome are based on cutting away the inflamed part of the IT Band to reduce the athlete’s pain and to prevent the the IT Band from rubbing against the bone. However, since the IT Band has been shown to contribute to the rotational stability of the knee, the surgeon should be careful with the amount of tissue excised in order to avoid compromising the function of the knee joint postoperatively.

Platelet Rich Plasma Injections

PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. PRP puts specific components in the blood to work. Blood is made up of four main components; plasma, red blood cells, white blood cells, and platelets. Each part plays a role in keeping your body functioning properly. Platelets act as wound and injury healers. They are first on the scene at an injury, clotting to stop any bleeding and immediately helping to regenerate new tissue in the wounded area.

We use PRP for numerous musculoskeletal disorders and there is a lot of research, including that published by our office which supports the use of PRP injections for problems such as IT Band Syndrome. However, there is little published research in regard to PRP specifically treating IT Band syndrome. As the IT Band is connected at the hip and the knee there is indirect evidence that PRP treatments can help IT Band syndrome by treating Greater Trochanter pain and knee problems cause by patellar tendinopathy and patella cartilage breakdown which something co-exists with IT Band syndrome.

Pain at the IT Band and the hip

The iliotibial band can cause hip pain, either through damage to itself or by causing an impingement of the gluteal tendons and hip bursa at the greater trochanter by the iliotibial band (ITB) as the hip moves into adduction, as when you lift your leg to the side.

In my article PRP treatments for hip bursitis and Greater trochanteric pain syndrome, I note:

  • Lately PRP has become very popular among the orthopedic community as a minimally invasive way of enhancing tissue healing. It is thought that PRP promotes soft tissue healing by delivering a higher than normal concentration of platelets and therefore increased concentration of platelet derived growth factors to the diseased area. This has been shown in various studies.
  • A January 2020 study published in the medical journal Cureus, (2) offered the following on the superiority of PRP treatments to cortisone:
    • 24 patients with greater trochanteric pain syndrome were enrolled and randomized into two study groups
    • In Group A patients received ultrasound-guided PRP injection treatment, while group B patients received ultrasound-guided cortisone injections. Clinical outcomes in both groups were evaluated and compared using various patient reported scoring systems.
    • Both groups showed improved scores compared to the pre-injection period, but patients in the PRP group had a statistically significant decrease in pain and increase in functionality at the last follow-up (24 weeks post-injection). No complications were reported.

PRP for knee tendons. The IT Band is considered a knee tendon

In my article on Patellar tendinopathy treatments I note that there is limited research as well in the role of PRP in helping patients with patellar tendinopathy. However a 2017 study (3) stated: “These limited studies are encouraging and indicate that PRP injections have the potential to promote the achievement of a satisfactory clinical outcome, even in difficult cases with chronic refractory tendinopathy after previous classical treatments have failed.” One of the studies reviewed was a study from researchers in the Netherlands. In this study, outcomes of patients with patellar tendinopathy treated with platelet-rich plasma injections (PRP) were evaluated to determine whether certain characteristics, such as activity level or previous treatment affected the results. What they found was: “After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful.”

A 2014 study in The American journal of sports medicine (4) offered these results and assessments:

  • “Chronic patellar tendinopathy is one of the most common overuse knee disorders. Platelet-rich plasma (PRP) appears to be a reliable nonoperative therapy for chronic patellar tendinopathy.”

The IT Band can be even more complicated

The problems described above are general overviews. When you get into actual patient stories, things can get much more complicated. Often our office will get contacted by someone who has a lot of issues and the IT Band being one of the many factors. A more typical email will tell us about knee and hip pain. The knee pain surrounds the patella and one of the many problems of maltracking or a patella out of groove. The same side hip will make snapping and clicking noises and create pain at the IT Band attachment. Back pain will creep in and despite physical therapy, exercise and any number of things you can buy on the internet as a self-help apparatus, nothing helps. From here the pain now creep into the groin. If this sounds like you. Send me an email so we can assess your candidacy for our treatments.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

1 Bolia IK, Gammons P, Scholten DJ, Weber AE, Waterman BR. Operative Versus Nonoperative Management of Distal Iliotibial Band Syndrome—Where Do We Stand? A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2020 Jun 10.
2 Begkas D, Chatzopoulos ST, Touzopoulos P, Balanika A, Pastroudis A. Ultrasound-guided Platelet-rich Plasma Application Versus Corticosteroid Injections for the Treatment of Greater Trochanteric Pain Syndrome: A Prospective Controlled Randomized Comparative Clinical Study. Cureus. 2020 Jan;12(1).
3  Gosens T, Den Oudsten BL, Fievez E, van ‘t Spijker P, Fievez A. Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments. Int Orthop. 2012 Apr 27. [Epub ahead of print]
4 Charousset C, Zaoui A, Bellaiche L, Bouyer B. Are multiple platelet-rich plasma injections useful for treatment of chronic patellar tendinopathy in athletes? a prospective study. The American journal of sports medicine. 2014 Apr;42(4):906-11.

Research: How effective is Stem cell therapy for a bone on bone hip and as an alterative to hip replacement surgery?

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Marc Darrow MD,JD

Your hip is bone on bone. Can you avoid a hip replacement surgery?

Over the years we have seen our fair share of people with a diagnosis of a bone-on-bone hips. The people we usually see have a lot of hip pain and instability which causes walking difficulties, balance difficulties and prevents these people from feeling stable on their feet. They also come in claiming that they have been told they only have one treatment option. Hip replacement and that they should get on the list to get one. Often they will ask, “Is hip replacement really my only option?”

“given time and educational materials to deliberate whether or not to proceed with hip replacement, more patients decide not to have surgery”

Some people come in with a diagnosis of avascular necrosis. Some of these people have been told that the only way they will ever get pain relief is from a hip replacement. There are cases where the bone is very damaged and it has collapsed completely. The hip joint is now fused and the person cannot move or lift their leg. This person will probably need a joint replacement. But most people I see with avascular necrosis of the hip or shoulder don’t need a surgery. Sometimes they only need a little education to help them understand what is happening in their hip and that they can avoid the hip replacement. There are many doctors like myself, who are upset that patients are not given the full story on hip replacement options and alternatives.  Read More

Waiting for hip replacement and spinal surgery. Is stem cell therapy a realistic option to help you avoid surgery?

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Marc Darrow MD,JD

Many people email us about their hip and back pain. Some have been recommended to a hip replacement, some have been recommended to a spinal surgery. Some have been recommended to both surgeries and they are in the process of choosing between one or the other and exploring options to help them avoid one or the other surgery, even both. Some at this point are not even deciding which to get first, they may simply take the first one that is available.

The question that comes in to us is about stem cell therapy as an option and “which would you treat first? My hip or my back?” The benefit of stem cell therapy is that in the same visit, if you are a good candidate for treatment, we can treat both of your pain challenges at the same time. In this scenario, both areas can begin a simultaneous healing process. You do not have to wait for you hip to heal to start spinal treatments, you do not have to wait for your back to heal to start hip treatments. Below I will discuss the science behind these treatments.

Research: The question of which to have surgery on first, the hip or the spine, is much more complex and risky than thought

The option to have lumbar spinal surgery and hip replacement at the same time is clearly one that is not recommended for obvious reasons. So a decision has to be made. Spinal surgery or hip replacement surgery? One has to come first and one has to wait.

At Washington University School of Medicine, Departments of Orthopaedic Surgery and Neurology and Physical Therapy, surgeons and therapists wanted to examine patients who had hip osteoarthritis and back pain. The hip-spine complex can be a tricky and complex area to diagnose. Finding the true source or sources generating a patient’s pain can be equally complex. This makes the first surgery decision even more difficult.
Read More

Stem cell therapy | An alternative to hip labrum arthroscopic surgery

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Marc Darrow MD,JD

We are getting many emails from people who are waiting for a hip arthroscopic surgery or trying to find other solutions. Now a leading surgical center, the Hospital for Special Surgery says this: “The percentage of patients with hip arthritis who had a hip replacement within two years of hip arthroscopy was unacceptably high at 68%, according to a new study of more than 2,600 patients by investigators at Hospital for Special Surgery (HSS). Prior hip arthroscopy was also associated with significantly worse outcomes after hip replacement.”

This was from a May 18, 2020 Press statement

“Arthroscopic hip surgery should not be performed in patients with a diagnosis of osteoarthritis”

This conclusion warning that people with hip osteoarthritis should not have arthroscopic surgery comes from Hospital of Special Surgery research published in the journal Hip International.(1) Here is the concluding remarks of that research:
Read More

Treatment of Hip Osteoarthritis with Platelet-Rich Plasma Injections

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Marc Darrow MD,JD

We have long used bone marrow derived stem cells and Platelet Rich Plasma injections as effective and reliable treatments for the patient with hip osteoarthritis. When a patient comes into our office, the realistic expectation of effectiveness of treatment is confirmed by a physical examination and a patient history. Following the consultation we sit down with the patient and present our recommendations for their hip pain treatments. How do we decide which treatment will be best? Many factors. For instance, a patient who wants to climb a mountain in a few months will need a different treatment program than someone who simply wants to walk up a flight of stairs without loss of stability and pain.Someone who needs to get back to work or not lose time from a physically demanding job will need a different program than a retired person with limited activity. In this article we will concentrate on when the choice is Platelet Rich Plasma Therapy injections as a primary treatment of hip osteoarthritis.

Platelet-Rich Plasma therapy is part of a group of treatments that come under the term “regenerative medicine.” PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration.
Read More

PRP treatments for hip bursitis and Greater trochanteric pain syndrome

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Marc Darrow MD,JD

Over the years we have seen many patients with hip pain. Many of them having a “hip bursitis.” If you have a diagnosis of bursitis, you know what it is, as most you have been diagnosed with a trochanteric bursitis or an iliopsoas bursitis. Sometimes both. The iliopsoas bursitis is felt in the groin area on the inside of the hip. The trochanteric bursitis is felt on the outer part of the hip.

However, most of the patients we see may or may not have a bursitis even though they have a diagnosis of one and they are on anti-inflammatory medications. Bursitis is an inflammation of the protective, fluid filled sacs that prevent excessive friction between the functional soft tissue of the hip, i.e., the ligaments and tendons, and the bones they attach to and rub against. These bursae can become irritated from injury, excessive pressure, and overuse .More often this diagnosis is actually a problem of tendonitis or tendinosis. However, for the purpose of this article, I will focus on the problem of bursitis.

Once a diagnosis of bursitis is made, the patient will typically be given a “healing,” regiment that will include:

  • Activity modification and rest
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Physical therapy.
  • Injection of a corticosteroid

These treatments may be effective for some, non-effective for others. Once the cortisone injection or injections fail to provide any relief, the patient will usually start seeking other options. One option is Platelet Rich Plasma therapy or PRP. PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. Why PRP?
Read More

Knee pain, back pain, and hip pain after knee replacement

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Marc Darrow MD,JD

In many patients that come into our office, there is a complexity of symptoms and pain in multiple joints. In one patient, for instance, it could be back pain, hip pain, and knee pain. In the patient history, we ask that patient if they have been recommended to any surgeries? Sometimes they will respond, “yes, I have been recommended to back surgery,” or sometimes they will say, “my spinal surgeon is suggesting back surgery, my orthopedist is recommending hip surgery. The two of them agree that I should have the hip surgery first then the spinal surgery.” Sometimes a patient will say that their doctors are recommending a spinal surgery, hip surgery, and bi-lateral knee replacement, which surgeries first are dependant on which is thought to be the worst of their problems.

In this article I will discuss research that suggests that in some of these situations, where a patient has hip, back and knee pain, the rush to surgery may be sending many patients to an inappropriate or unnecessary surgery knee replacement.

Fixing a problem that is not there, 21 patients who were referred to knee treatments, but who in fact had a hip problem,

If you have an MRI of your knee and it shows degenerative arthritis and you tell your doctor that your knee hurts, there is a strong possibility that you will be recommended to knee replacement.
Read More

How long do stem cell treatments last?

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Marc Darrow MD,JD

When a patient comes into our office and we have made a realistic determination that they are a stem cell candidate, the patient will often ask, “How long does the stem cell treatment last?” Most times I will have a good idea why they are asking the question. The reason is because nothing they have tried up until this point has been a long-lasting success for them. In going over a hip or knee osteoarthritis patient’s history for example, we will discover a medical history filled with treatments that in many instances did provide short-term benefit. You have probably had a few of these treatments yourself. Let’s go through the treatments.

Cortisone injections. Corticosteroids are powerful anti-inflammatory substances. They are not used to relieve pain, but rather, to reduce inflammation. Reducing inflammation can lessen a patient’s level of discomfort in the short-term. Numerous studies over the years, however, have demonstrated that there is a steep price to pay for that temporary relief of discomfort. The price of prolonged use of cortisone? Cortisone will eventually cause degenerative joint disease in the joints they are injected into. I explain this further is my article Systemic side-effects of cortisone injections.

Doses of anti-inflammatories. In the many years that we have treated patients with degenerative joint disease, there has always been the instance when a patient will ask us if they can continue with their anti-inflammatory medications. The answer is typically no. When the patient asks why? We have to remind them that regenerative medicine techniques like the ones we use, count on the beneficial aspects of inflammation. Inflammation is the way Nature heals. If we stop the inflammation, we stop the healing.

There is a steep price to pay for the short-term benefits of anti-inflammatory medications. Read More

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