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PRP decision frustrates Kreitzburg

Brock Kreitzburg isn't Tiger Woods. He isn't worth a billion dollars, and he has no multi-million dollar sponsorship deals to lose. Home Depot was his sole sponsor, and he lost that in March when the company cut its Olympic sponsorship program. Kreitzburg is in Germany now, traveling as part of the U.S. bobsled team, hoping to make his second Olympics as a bobsled pusher.

Kreitzburg does have one thing in common with Woods though: He, too, wanted platelet-rich plasma (PRP) therapy, the recuperative treatment that Woods reportedly received from Dr. Anthony Galea, the Toronto-based physician who is facing drug-related charges in Canada and an FBI investigation in the U.S. after his assistant was stopped at a border crossing in September with illegal drugs and human growth hormone.

Kreitzburg, with driver SteveHolcomb, won the World Cup championship in two-man bobsled in 2007. But by fall 2008, his path to a second Olympics was derailed by hip problems that landed him on the operating table -- twice. He had an arthroscopic procedure to fix a torn labrum in September, and in November a highly invasive procedure in which his pelvis was cut in five places, rotated, and screwed back into place to prevent hip dislocations. To help him recover, Dr. Marc Philippon, a world-renowned hip surgeon who has fixed the hips of GregNorman and MarioLemieux, among others, last spring recommended PRP therapy. However, when Kreitzburg submitted forms to the United States Anti-Doping Agency (USADA) asking if he could go ahead with it, he was denied -- as Tiger might have been were he an Olympic athlete.

In PRP therapy, some of the patient's blood is withdrawn and the platelets are separated from the plasma. The platelets are then reinjected to promote healing. The technique has grown increasingly common among athletes looking for quick recovery. Its rapid ascent into the elite echelon of sports forced the World Anti-Doping Agency (WADA) to consider this year whether it should be allowed -- and finding that PRP therapy is not performance enhancing, WADA added it to the list of acceptable procedures. In 2009, though, if any athlete wanted PRP therapy, they were required to get a "therapeutic use exemption," explaining a legitimate medical need for the treatment. With the new WADA decision, as of Jan. 1, 2010, athletes in Olympic sports will be allowed to use PRP therapy so long as the platelets are injected into a ligament or tendon, not into muscle. The reason for the distinction is concern that an injection into muscle could enhance muscle growth -- though that theory has yet to be proved.

When Kreitzburg wanted the therapy last spring, his request for a therapeutic use exemption went to the FIBT, the world governing body for bobsled. On May 19, he got a letter denying his request. The reason given was that "there are alternative medicine on the market and it is not standard care."

For Kreitzburg, the inability to receive PRP therapy meant he had to have nine cortisone shots over four months this year to cope with pain so that he could attempt to qualify for the U.S. national bobsled team (he made the team in October). Philippon says that the pace of Kreitzburg's recovery was startling, but that he was very disappointed that Kreitzburg was denied the PRP treatment, and says he likes to use it on patients-though he says he does not do so with Olympic athletes for fear of their getting suspended. "Any time you manipulate the blood, I think they're worried about blood-doping," says Philippon. "I understand the worry, because you're always going to find people who manipulate it for an illegal advantage."

PRP therapy, however, is not blood doping. Dr. Allen Mishra, clinical assistant professor of orthopedic surgery at the Stanford University Medical Center, has been using PRP therapy for nearly a decade, and published a study in 2006 that demonstrated its effectiveness in recovering patients. Mishra says athletes tend to drive the demand for PRP therapy because they are looking for any new procedure that can help them recover faster from injury. Mishra says PRP therapy should decrease oxygen-carrying capacity, not increase it like blood-doping does, because blood is taken out of the blood stream and injected into tendons or ligaments, areas that don't normally have a good blood supply. "It's made at the point of care," Mishra says. "It's not held out and processed and then reinjected into you before the Tour de France."

Athletes in non-Olympic sports, and thus not overseen by WADA, have been using PRP therapy in muscle tissue. In September, the New York Daily News reported that Dr. Jonathan Glashow, co-director of sports medicine at Mount Sinai Medical Center in New York City, had given PRP injections into the muscles of baseball players to enhance recovery from hamstring injuries.

Kreitzburg was left frustrated that his surgeries came just about a year before the approval of PRP therapy by WADA. When he heard that PRP therapy has been deemed appropriate by WADA for 2010, Kreitzburg said in an e-mail from Germany that "I can't tell you how frustrated I am right now."

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