Knee 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
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

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 on stem cell therapy for knee osteoarthritis and bone on bone knees

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Marc Darrow MD,JD

In this article I will present research on the use of stem cell therapy treatments for knee osteoarthritis. I will discuss published research by the Darrow Stem Cell Institute on the use of bone marrow derived stem cells. I also invite you to ask your questions using the form below about your knee pain.

Stem Cells Instead of Knee Replacement?

Over the years it became clear to many researchers that knee replacement had to be redefined and disputed as the gold standard of knee osteoarthritis, “bone-on-bone,” treatment. Other doctors, however, had already decided to abandon joint replacement and explore growing tissue as the new standard of care. The thinking was simple—why remove bone and tissue when these could be repaired and rejuvenated?
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Platelet Rich Plasma Injections for knee osteoarthritis

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Marc Darrow MD,JD

While we do offer stem cell therapy for knee osteoarthritis, the focus of this article will be on Platelet-Rich Plasma Therapy. We receive many emails which ask which is the better treatment, stem cells or PRP? That answer comes best when explored on an individual basis, following a physical examination, and, when we have the opportunity to sit down together and discuss what are your goals of treatment.

In the same regard, we get many emails that ask us if PRP is better than hyaluronic acid injections or cortisone injection. Hyaluronic acid injections and cortisone can help many people in the short-term. This is well documented in the the medical research, some of which is cited below. However, in our experience, we have found PRP injections to be the superior treatment when compared with hyaluronic acid injections or cortisone injection.

A study published in January 2021 (1) examined the combined research of 24 previously published studies on the possible benefits of PRP therapy in knee and hip osteoarthritis patients. The findings of this study suggest that PRP injections significantly improved pain, stiffness, function, and disability levels compared with the other injection treatments it was compared against. Intra-articular PRP injection provided better effects than other injections for osteoarthritis patients, especially in knee osteoarthritis patients, in terms of pain reduction and function improvement at short-term follow-up at 1 month, 2 months, 3 months, 6 months, and 12 months.

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Side-effects of corticosteroid injections including joint destruction

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Marc Darrow MD,JD

Systemic and local side-effects of corticosteroid injections including joint destruction

A patient will often come into our office with conflicting ideas about cortisone injections. The patient will tell us that his/her other doctors told them that cortisone injections are safe, effective, and will help their pain, if used sparingly. But, intuitively, the patient had doubts and concerns.

But as this patient continued to wait for a surgery, decisions had to be made as to how much pain management would be needed to “hold them over,” until the surgical date.

Corticosteroids are powerful anti-inflammatory substances. They are not used to relieve pain, but rather, to reduce inflammation, which in turn can lessen a patient’s level of discomfort. Numerous studies over the years have shown that prolonged use of cortisone will eventually cause degenerative joint disease in the joints they are injected into.

UNDERSTANDING THE POSSIBLE COMPLICATIONS OF CORTISONE INJECTIONS.

A December 2020 paper in the medical journal Radiology (1) says this:

  • Current management of osteoarthritis is primarily focused on symptom control.
  • Intra-articular corticosteroid injections are often used for pain management of hip and knee osteoarthritis in patients who have not responded to oral or topical analgesics.
  • “Recent case series suggested that negative structural outcomes including accelerated osteoarthritis progression, subchondral insufficiency fracture (stress fractures in the bone beneath cartilage), complications of pre-existing osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received Intra-articular corticosteroid injections .
  • The true cause and natural history of these complications are unclear and require further study. To determine the cause and natural history, large prospective studies evaluating the risk of osteoarthritis or joint destruction after Intra-articular corticosteroid injections are needed.

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Stem cell therapy, PRP or hyaluronic acid knee injections?

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Marc Darrow MD,JD

Many patients we see, have been researching their options in treating their chronic knee pain. These people come to see us because they are exploring non-surgical alternatives and have investigated various forms of regenerative medicine techniques. This includes the use of their own blood platelets as a healing solution, (more commonly referred to as Platelet Rich Plasma Therapy) or stem cell therapy which we will discuss below in relation to hyaluronic acid injections.

Many of these patients, perhaps including yourself as well, have had prior discussion with doctors about hyaluronic acid injections. These injections can provide a good amount of pain relief, temporarily. But ultimately they do not regenerate tissue and they are only a stop gap measure to delaying inevitable joint replacement.

  • Hyaluronic acid is a naturally occurring substance that is a major component of the protective synovial fluid that surrounds the knee. In its natural form it is also a key component of wound healing. In its processed form used for injection purposes, hyaluronic acid is NOT a key healing component as attested to by suggestions and recommendations that these injections are stop gaps until knee replacement can be performed.

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Can stem cell therapy repair and regenerate cartilage inside your knee

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Marc Darrow MD,JD

Stem cell therapy works in a multi-factorial way. Stem cells repair, stem cells regenerate, and stem cells communicate. Communication is one of the key but less understood functions of stem cell therapy. In this communication aspect, newly introduced stem cells (those introduced in stem cell therapy injections) can mobilize stem cells already in your knee to jump start a new repair cycle for degenerative and acute injury damage.

In 2011, doctors at the University of Aberdeen published research in the journal Arthritis and rheumatism that provided the first evidence that resident stem cells in the knee joint synovium underwent proliferation (multiplied) and chondrogenic differentiation (made themselves into cartilage cells) following injury. (1) This paper, presenting the idea that stem cells in an injured knee increased in numbers in preparation of healing has been cited by more than 68 medical studies.

One of the more recent of these 68 papers is a June 2019 study (2) in which researchers suggest that in both rheumatoid arthritis and degenerative arthritis, communication between the native cells in the damage knee causes an increase of stem cells found in the synovial fluid.

A new study in The journal of knee surgery,(3) May 2020 noted that synovial fluid-derived stem cell population increase exponentially in patients with joint injury or disease, pointing to a potential use as a biomarker or as a treatment of some orthopaedic disorders.

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When anti-inflammatory medication accelerates the need for knee replacement

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Marc Darrow MD,JD

As we see more patients looking for alternatives to knee surgery who are being pain managed along with anti-inflammatory medications or NSAIDs (non-steroidal anti-inflammatory medications), and painkillers, one question they all seem to have is: “What are these medications doing to my knees.” The simple answer is, they are destroying your knees, and the research to support this goes back a long way. In fact it was in 1993 that Dr. MJ Shield wrote in the European journal of rheumatology and inflammation (1) that “Growing evidence suggests that nonsteroidal anti-inflammatory drugs (NSAIDs), while able to alleviate inflammation, may damage articular cartilage.” How? By preventing the growth of new cartilage.

Nothing has changed in 27 years. These medications are continually shown to accelerate knee damage.

But, NSAIDS can make knees feel better in the short-term, and in the long-term in greater doses. In the over 20 years that we have treated patients with knee problems, 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 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.

This simple statement, that inflammation is Nature’s way of healing has been the subject of decades long debate in the medical community. Many doctors argue that you have to shut down inflammation to prevent more damage. For decades, cortisone became the weapon of choice. Cortisone as doctors would later find out, would destroy joints and contributed to the great surge in joint replacement surgeries.

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Once you get a knee replacement, how fast can you get back to work or your sport?

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Marc Darrow MD,JD

Research: Realistically 9 to 30% of patients do not return to work after knee replacement

Before I begin, let me state that some people get great benefits from total or partial knee replacement. But not everyone is convinced it will be of great benefit to them or realizes the expectation they had going into knee replacement that they would come out with a pain-free knee with increased mobility. Some people are willing to wait months for their knee replacement, some people try to avoid the knee replacement because they have a lot of concerns about lengthy rehabilitation, down time, ability to return to work or some type of sport and the possibility that something can go wrong. Some people get the knee replacement because they think everything will go right.

“Not what I expected”

In January 2020,(1) doctors in Sweden produced an ambitious study to try to understand why a patient was not happy with their knee replacement when there were no obvious reasons that they should be. Especially when the surgery went without complication and was considered successful.

Here are some of the problems the patient reported and how it hindered them in their daily routine or trying to get back to work. Read More

How accurate are MRI scans of the knee?

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Marc Darrow MD,JD

We get many emails from people asking us about our ability or the ability of stem cell therapy to repair their knee damage. Some of these people have had a recent MRI and a report of what the MRI recorded and what the radiologist interpreted. Some of these MRI reports are deep and comprehensive in their description of an unseemingly insurmountable amount of damage to the person’s knees. The person who sends in the email will sometimes add something in the email to suggest that their MRI is one of the worst that their doctor has ever seen. The funny thing is when we ask, “well how does your knee feel today?” Sometimes we get the answer, “not bad.” How can someone who has one of the worst knee MRIs their doctor has ever seen,have a knee that is “not bad”? That is what a lot of research is focusing on.

We also get emails from people who have terrible knee MRI reports and a have a frozen joint, fused by excessive bone spurring. These people cannot bend their knee. In these situations where knee range of motion is compromised, increasing functional ability may not be a realistic goal of stem cell treatments, a discussion with this person would turn towards an assessment of the treatment’s ability to help with their pain. Not every person with damaged knees is a good candidate for stem cell therapy.

However for the patient who is active, has a good range of motion in their knee, can bend their knee, even with a bad MRI, this person would be considered a realistically good candidate for stem cell therapy.
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Stem Cell Therapy Alternative For Meniscus Surgery

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Marc Darrow MD,JD

Many people today are exploring meniscus surgery alternatives. One reason is that they may be on a waiting list to get the surgery. Another is that they have been doing research and are not absolutely convinced that meniscus surgery will help them anyway.

Meniscus repair surgery, opinion as of 2020: “in the knees without the meniscus, the impact and load are three times higher.”

A 2020 study in The archives of bone and joint surgery (1) offers an updated opinion on meniscus surgery. Here are some points brought up by the surgeon researchers.
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