Have you been told that Platelet-Rich Plasma (PRP) therapy doesn’t work, or have you tried it yourself with zero relief? The truth is, not all PRP is created equal, and a botched preparation or misdiagnosis could be the real reason behind a failed treatment. In this episode of The Regen Doc, Dr. Aneesh Garg pulls back the curtain on the regenerative medicine industry to explain exactly why standard clinics often fall short and how to ensure you are getting authentic, high-quality care. This episode is a must-listen for anyone suffering from joint pain or sports injuries who wants to avoid surgery and understand what actually goes into a successful regenerative treatment. Tune in to discover the crucial questions you need to ask your provider so you can stop price shopping and start outcome shopping.
- The Information Gap: Why traditional, insurance-based doctors often dismiss PRP simply due to a lack of training in regenerative medicine.
- The “Fake” PRP Problem: Why a heavily discounted $500 injection might just be a vial of unspun blood instead of true therapeutic PRP.
- Diagnosis Dictates Success: Why having the world’s best PRP won’t matter if the underlying diagnosis is wrong.
- The Science of Preparation: Crucial metrics to look for, including proper blood draw volume, centrifuge protocols, and targeting over 10 billion platelets.
- Delivery is Everything: The absolute necessity of using ultrasound guidance instead of “blind” injections.
- Spotting Red Flags: How to tell the difference between a highly trained specialist and a pop-up “stem cell clinic,” and when you should immediately walk out the door.
- Navigating Second Opinions: Why a confident, patient-first doctor will never be offended if you want a second opinion.
- Ethical Medicine: Why Dr. Garg will turn away paying patients if standard surgery is genuinely the correct path for their injury.
- Not All PRP is the Same: The success of PRP heavily depends on the preparation protocol and achieving a high platelet concentration (over 10 billion platelets), which many basic kits fail to deliver.
- Blind Injections Are a Waste of Money: Even the most perfect biological sample won’t heal you if it is injected into the wrong spot; always ensure your provider uses ultrasound guidance.
- Diagnosis is Paramount: The most advanced regenerative treatments in the world are completely useless if the core problem hasn’t been accurately identified first.
- Beware of Price Shopping: Opting for the cheapest regenerative treatment often leads to sub-optimal outcomes, meaning you’ll likely end up paying twice. Focus on “outcome shopping” instead.
If this episode empowered you to take control of your healing journey, please follow, like, and share The Regen Doc podcast with friends and family who could benefit from this information!
To learn more about his practice, ask questions, or see if regenerative medicine is right for you, visit DynamicAthlete.com.
Chapters
- 0:00 Hook: Somebody told you PRP didn’t work
- 0:36 Why so many doctors say PRP doesn’t work
- 3:31 Isn’t PRP just PRP? Diagnosis first, then preparation
- 5:43 What real PRP takes: blood volume, spins, 10 billion platelets
- 8:26 The questions to ask before you get PRP
- 10:49 Stem cell clinics everywhere: how to vet who is treating you
- 12:29 When surgery really is the answer, and second opinions
- 16:22 Success rates, downside, speed, and who I turn away
Questions this episode answers
Why didn’t my PRP injection work?
In my experience, it’s usually not that PRP doesn’t work, it’s that not all PRP is the same. Bad PRP and suboptimal PRP don’t work. Too little blood drawn, too few spins, a platelet count nowhere near 10 billion, no ultrasound guidance, or a wrong diagnosis will all sink the result. When someone tells me their PRP failed, I ask who did it, how, and what the protocol was before, during and after.
Why do so many doctors say PRP doesn’t work?
Most doctors work inside the insurance model, so it’s hard to recommend something insurance doesn’t cover. They default to what is covered: a steroid injection, physical therapy, then surgery. Most physicians were also never trained in regenerative medicine. In residency you learn to give a steroid shot and refer to a surgeon. And when a study says PRP failed, nobody asks what kind of PRP it was or whether it was injected blind.
What decides whether a PRP injection actually works?
It comes down to the details, and that’s the whole point of this episode. The outcome depends on how much blood is drawn, how many times it’s spun, what concentration you’re reaching, whether it’s delivered under ultrasound, how experienced the person doing it is, and how it’s protected afterward with the right rehab. Above all else, the diagnosis has to be right. The most pure PRP in the world injected in the wrong place doesn’t matter.
How many platelets should a PRP injection have?
Those of us in the know talk about more than 10 billion platelets. Getting there takes a real volume of blood, a proper centrifuge and the right number of spins, not a little vial drawn and handed back to you. If a provider takes a small vial of blood and calls it PRP, that’s not PRP. And if nobody can tell you the platelet number they’re targeting, walk out.
What questions should I ask before getting PRP?
Start with: how confident are you in my diagnosis, and has anyone actually checked this? Then ask how much blood you draw, how many times you spin it, what X multiple you’re targeting, and how many billions of platelets. Ask whether you inject under ultrasound guidance. And ask how many of these you’ve done: is this a side project, or is it what you do all day, every day?
Does PRP need to be injected with ultrasound guidance?
I think it’s huge. When I say an injection is done blind, I don’t mean eyes closed, but it might as well be, because there are a lot of studies showing how much more accurate ultrasound is. You can have the most perfect PRP out there, and if you’re not putting it exactly where it needs to go, what are we doing? Delivery and the experience of the person delivering it change the outcome.
How do I know if a stem cell clinic is legitimate?
Vet the background of whoever is doing the procedure. Nobody would ask a surgeon which scalpel to buy so they could start operating; there’s training involved, and the same is true here. Be careful with pop-up clinics. We saw a case the day we recorded this: an injection done elsewhere went sideways, got infected, and sent her to the hospital. And if you sense money is the main motivator, walk out.
My surgeon says surgery is the only fix. Should I get a second opinion?
When it’s a true surgical indication, your surgeon is right, and I tell patients that myself. I trained in fellowship alongside some of the best orthopedic surgeons in the country, so I know when someone needs surgery. But you can’t go backwards once it’s done, so be sure. Get another opinion. If the person you’re seeing gets annoyed that you want one, walk right out: they’ve made it about themselves, not you.
Can a PRP injection make my injury worse?
Set the cost aside for a second and look at the actual treatment. PRP uses your own blood, and the goal is to help the tissue heal. There are the usual injection risks, infection being the main one, which is another reason who does it and where matters. I walk through the risks for your situation at the visit, before anything is done.
Will a regenerative medicine clinic tell me I’m a candidate just to sell me a procedure?
Not here. We don’t do procedures unless I feel good that we’re doing it for the right reason. A man walked in ready to pay up front and asked me to fix him. I told him he needed surgery, that what I do would not fix his problem, and not to let anyone do this to him. I’ve also turned down a PRP request when I didn’t think it would work for that problem.
Transcript
Speaker labels are inferred from the caption export’s turn markers (a short question is Nicole, the practice manager; the rest is Dr. Garg). Dollar figures spoken on the recording are shown as [amount] in this lightly edited transcript.
Hook: Somebody told you PRP didn’t work 0:00
Dr. Garg: Welcome to the Regen Doc podcast. I’m your host, Dr. Aneesh Garg, and we’re going to get into why my PRP isn’t working. Somebody told you that PRP didn’t work. It could have been your mom. It could have been a friend. It could have been Google or you had PRP and it didn’t work. And I think the most part, it’s not that PRP doesn’t work, it’s that not all PRP is the same. And we’re going to get into why.
Nicole: Okay. So, I have a couple questions for you. First one, if PRP is real, why do so many doctors say it doesn’t work?
Why so many doctors say PRP doesn’t work 0:36
Dr. Garg: It’s a great question. I think there’s a lack of knowledge in terms of what PRP is and regenerative medicine is. And I think most doctors are in the insurance model. So, it’s hard to recommend something that insurance doesn’t cover. So then they default to things that are covered like a steroid injection or physical therapy or whatever what have you and even surgery that’s covered by insurance. But what happens with those people that are in between getting injured and having surgery? And that’s the challenge here. I think most physicians don’t understand what PRP and regenerative medicine is all about. And then when they try to look at things, they don’t know that all PRP is not the same. Even when you look at research studies and people will say, well, I read a research article on PRP or stem cells or shockwave and it doesn’t work. And then you get into what kind of PRP was injected or was it even injected with ultrasound guidance or was somebody doing it blind? And when I say blind, I don’t mean with their eyes closed, but it might as well be the same thing because there have been a lot of studies that’ll show the evidence in terms of accuracy when you use ultrasound. So we had a story or we had a patient when he came in had PRP done and said yeah my doctor just basically you know old school where they just could take a bite and like take the needle out and then they inject it and that’s basically what it was and uh and so you know and he was surprised it didn’t work and I said yeah there’s a lot there’s a lot of things wrong in that scenario. So uh I mean I think that’s really a big thing. The other thing too is that most physicians are never trained on this, right? And I think that’s the other component that they’re not trained. So they don’t know about it. There’s no background backstory to it. In residency, you’re trained to give a steroid injection. You think that’s the answer. And if you can’t do anything more, then you send an orthopedic surgeon, right? And I think that’s where people sit. And so they don’t know the difference there. And I think I think when we get into that, it’s really about not all PRP is the same because you could go get a kit tomorrow and say, “I do PRP and charge [amount] for it.” And somebody will come to you because you’re charging [amount] right? And then you get into the price shopping component of it, too. So, I think that’s really the reason why so many doctors will say it doesn’t work. Do you want him to just keep going so we’re not stopping in between each seg segment? Okay, question two. Isn’t PRP just PRP? How different can one injection really be?
Isn’t PRP just PRP? Diagnosis first, then preparation 3:31
Dr. Garg: It’s wild, right? Imagine you’d be like, “Well, I got PRP. It’s totally fine.” You know what happens in our clinic? So, when somebody comes in and says, “I’ve had PRP done. It didn’t work for me.” And then I ask, “Well, all right. Who did it? How did they do it? What was their pre-procedure protocol? What did they do during the procedure? What did they do after? when was your follow-ups? And then they look at me like, what are you talking about? And then I talk about, well, how much blood did they take out? What’s their X multiple? How many billions of platelets are they trying to get to? You know, did they use ultrasound? All this stuff that goes into it and they look at me like, what are you talking about? And so that’s what I get into. And I say, it’s not that the PRP doesn’t work in general. I think some bad PRP doesn’t work. I think suboptimal PRP doesn’t work. And I think you have to know what you’re doing with it and why you’re doing it to be able to work. And the other thing too that that is above all else, you have to get the diagnosis right. I think that’s really the big thing here, right? Imagine if you have the most pure PRP in the world and you inject it in the wrong place. It doesn’t matter. It doesn’t matter. and then you’re going to say PRB didn’t work then what are we doing right and so I think that’s the component so there’s a lot to do from a preparation standpoint but even before you get blood drawn is this the right diagnosis and I think that’s really one of the big things is that a lot of times when people come into our office the diagnosis isn’t correct and then we’ll ask them and say has anybody ever checked this on you and they say no, never. And so that’s where we get into that. I don’t care how great your PRP is. If your diagnosis is wrong, if you’re not actually going after for like what’s the problem, then then I think you’re going to miss the boat regardless of whatever PRP is there. All right. So, let’s let’s go on the premise that PRP is now or let’s go on the premise that the diagnosis is correct. Okay, everybody’s on the same page. We’ve got
What real PRP takes: blood volume, spins, 10 billion platelets 5:43
the diagnosis. Now it’s about the preparation of the PRP. How much blood do you take out? How much or how much blood do you take out? What is the concentration you’re trying to get to? How many billions of platelets? Right? Those in the know, we talk about this all the time about more than 10 billion platelets. And then how do you get to that? And that’s a conversion factor and all that stuff. But if you’re taking like this much cc’s of blood and then you shrink it down to like that much, I’ll tell you what, you’re not getting to the platelet level. So if anybody’s getting PRP done when they take a little vial of blood and call it PRP, I want you to stop right now and walk right out because that’s not PRP. I don’t care what anybody tells you, that’s not PRP. So you look at that and then you look at the centrifuge and are they spinning it? How many times are they spinning it? Are they just doing this and then basically injecting it back into you or are they using a centrifuge?
Dr. Garg: For our readers, can you or not readers, for our listeners, can you
Dr. Garg: Yeah, that’s a centrifuge, right? So are they just hand centrifuging like this or are they actually using it? How many times do they spin it? And I think that’s really the the big thing. And and how are they delivering it? So say you got that all down. Great. And then how are you delivering it? are using an ultrasound to really pinpoint where you’re putting it. And I think that’s huge. Again, you can have the most perfect PRP out there. And if you’re not putting it where you want to put it, then then what are we doing, right? And then that comes down to experience of who’s doing it. And I think that’s the that’s one of the things. So all these variables can change the outcome. And then what how are you protecting it afterward? What is your PT situation like afterward? Uh and so all these variables can impact the outcome. And so if you price shop and you just base things on how much things cost, then these are the variables I think you’re leaving on the table here. So I think that’s the challenge is are you price shopping or are you outcome shopping? And I think that’s what if you’re going to pay money out of pocket, I I think you probably should be chasing outcomes in that reg in that respect because there’s there’s plenty of there’s plenty of people that that will do that. And I think those are the ones that end up paying twice because they’ll get it done cheaper somewhere else and then they’ll end up coming to us and say, “Okay, I think I need to have this one.” Right.
Nicole: Okay. So, now that you’ve explained that, what should I ask before getting PRP to know I’m getting the real thing?
The questions to ask before you get PRP 8:26
Dr. Garg: There’s there’s a lot that goes into it. I mean, I think the the big thing when you’re asking, how do I know if I’m getting the real thing? It’s the questions that I ask the patient or any of my athletes that come in when they said they’ve had PRP elsewhere. So, what’s how much blood are they taking? Right? And this is where you can do your homework. uh h how many spins are we doing? What is the x multiple that you’re trying to get to? The first thing I would say is how confident are you in the diagnosis? Right? We go back to the same thing. How confident are are you that this is my problem? And then above all else, that has to be true. Right? You can’t go you can’t go forward without actually knowing what the problem is. So, so once we’ve established a problem and I think I think that’s the component of how you can tell that there’s really good PRP or not and so that component and and you look at some of the metrics in terms of the centrifuge and and how many G forces and you start getting really scientific. I don’t think you really need to go down that road. I think the big thing is the volume of blood. How many times are they spinning it? And then what X multiple are you trying to get through and then how many billions of platelets, right? 10 billion platelets or more. That’s what you got to remember. And that’s if somebody’s not telling you that number, walk out. Walk out. So I think that’s really the big thing uh with those. And then really how many have you done, right? Is this something that’s a part of your practice as a side project or a hobby or is this something that you do all day every day? And I think that’s a question that most people sort of miss out on is sort of from an experience standpoint. So I think if any of this stuff resonates you, I would tell you guys to go to DynamicAthlete.com and just sort of see and read and and see if anything resonates with you and happy to help if if we can. So, uh, but hopefully that’s gives people the foundation in terms of what questions to ask.
Dr. Garg: Great. I’m going to play the role of a skeptical patient now and ask you some uh pointed questions.
Dr. Garg: Great. So, let’s do it.
Nicole: The first one, I’ve seen stem cell clinics pop up everywhere. How are you different from those places?
Stem cell clinics everywhere: how to vet who is treating you 10:49
Dr. Garg: Yeah, there’s there’s a lot, right? There’s a lot of people that want to get into this regenerative medicine game as I like to call it. And so when I go and lecture and I ask about or I get asked about this and I said, “Well, what do you do? What do you need to get into this?” And I and I kind of often joke about this and I’ve said this on a different podcast where where I asked him, I said, “Well, if you asked an OBGYn doctor, how do I get in the baby catching business? What do I do? Do I just get some sticky gloves? Like, what do I need to do to just catch the babies? or do you ask an orthopedic surgeon, you know, how do I get into the orthopedic surgery game? Like, well, like what kind of scalpel do I need to go get and start to do it? Well, obviously there’s training involved. So, I think that’s the component. And again, I go back to the same thing for us. It’s about doing the right thing for the right reason. And so, so that’s really the big thing. So, I would tell you the these things that are these stem cell clinics or or PRP clinics or whoever, I think that’s the big thing. I’d be very careful. I would I would vet the background of who’s doing what you’re what you’re doing, right? I mean, we had a case today. Somebody walked in and had an injection done and it went sideways, infected, had to go to the hospital, had to get her skin um taken care of with antibiotics. It was a mess because she went somewhere else and who knows what they were injecting. So, I think be very careful with that.
Nicole: Okay. My surgeon said surgery is the only real fix. Why should I believe you over them?
When surgery really is the answer, and second opinions 12:29
Dr. Garg: I mean, I think there’s truth to that when it’s a true surgical indication. I mean, that’s where I feel very fortunate. Look, I I got to do fellowship at the American Sports Medicine Institute in Birmingham, Alabama. So, it’s inside the Andrews Sports Medicine and Orthopedic Centers, which is one of the best places you can possibly go for sports medicine, if not the best. I’ll just say it’s the best, right? Because I went there, so it’s the best. But, uh, it’s really the best because of who’s there. And I got a chance to work with some of the best orthopedic surgeons in the country by far. And so for me to know these surgical indications and understand when people need to have surgery, I think that’s a huge value and a huge asset. So there’s a lot of times when I’ll tell people, hey, I don’t think this is going to work for you here. I think you need to have surgery. So I don’t I don’t disagree with that statement. I think there’s there’s a a absolute valid point with that, but it has to be a true surgical indication. And how do you evaluate when it’s a true surgical uh indication as a patient?
Dr. Garg: I think that’s where if if that’s if that’s part of your process, then I think that’s getting another opinion just to make sure everybody’s on the same page. Um here’s another tidbit. If you want to get a second opinion, and I’ll talk to you guys right there. If you want to get a second opinion and you start to feel some vibe shift or the person that you’re seeing gets annoyed that you want to get a second opinion, walk right out. Just walk right out because what they’ve done is made it about themselves and not you. And I think that’s really the big thing, right? So when somebody says to me, “Hey, I want to go get a second.” I said, “Great.” They may see something that I don’t see. And so I’m fine with that. And so it doesn’t hurt my feelings. And so I think that’s what I would do is just if you’re going to go and get surgery, I think that’s the big thing is do I really need this? You can’t go backwards. Once you get it, you can’t go backwards. So you better be sure that that’s the right call. And we talked about 90% of these over 90% of these don’t actually require surgery, right? There’s a lot of there’s a lot of great advances for what we can do from a from a non-surgical standpoint.
Dr. Garg: You told the story about uh the bad experience with the PRP. So, tell me more about why getting a PRP injection with you would be different.
Dr. Garg: Well, I think I think we we address all those questions, right? I mean, I think part of that training and that rigor is that this isn’t a one-off thing for us. We hunt for these things, right? Right? I mean, I don’t hunt in real life. I mean, but we’re hunting for what the diagnosis is. And what are we going to do about it? That’s really the big thing. And I often say this that if you’re in my family, this is what I would tell you to do. I don’t know any other way. And I think at the end of the day, that’s how you know that you’re going to be taken care of, right? And I think that’s really a big thing. And and I think a lot of times, we’ll go back to one of your earlier questions about why are these stem cell clinics popping up? I think if money is your main motivator and you get a sense that money is the main motivator, walk out. Just walk out, right? I mean, I’ve said it probably four times on this podcast already about when to walk out. I think that’s really the thing. The money factor can’t be your primary motivation. I understand you got to run a business. I get it. But it can’t be your primary motivation. And if that’s the case, then you’re in the wrong space. So for us, it’s about figuring out what it is and then we figure out how do we get there? And so I think that’s what’s the difference.
Success rates, downside, speed, and who I turn away 16:22
Dr. Garg: Okay. Can you tell me about your success rates? Yeah, I I mean I tell you when we combine the things that we’re doing and certainly, you know, I’ve said this before, there’s not a single clinic in the country that has the combination of things that we have with the combination of the PRP and stem cells and the shockwave and the pelvic floor and the and the mental wellness things we have. So, nobody has what we have in that space. And so, it’s been really great. I mean, over 90% of our patients are at least 75% better by their own admission post treatment. So, nine out of 10 times we’re getting you back to pretty close to to full speed. Somebody’s got to be in 10% and I understand, but but I think that’s a pretty big number and pretty big uh success rate to be able to do. And I think part of that is is that we don’t do procedures unless we feel good that I feel good that we’re doing it for the right reason, right? I had somebody who came in and said, “Well, I can’t afford the stem cell. How about we just do the PRP?” I told them I wouldn’t even do it. I said, “I don’t want to take your money. Please don’t do this because I don’t think it’s going to work for you here.” So, I would rather you not do that and potentially we could look at other routes where we’re just doing shockwave or whatever just to get them through until they can get uh the financial means to be able to do it. But, I mean, I think that’s that’s where again I would tell them I go I think you’d be wasting your money if we went this particular route. So, that’s at the end of the day you have to be able to do things for the right reason. So, you mentioned um that it may not work and we’ve talked about the reasons, but say I’m in that 10%. Am I worse off than before if I get an injection?
Dr. Garg: That’s a really good question. I mean, I don’t think you’re going to regret doing anything that we talk about. There’s virtually no downside to what we’re doing. If you put your investment aside, you put your cost aside for a second and you say, “Okay, the actual thing that we’re doing, there is in my mind zero downside, right? Obviously risk of infection or whatever you want from an injection standpoint, but by and large, you’re going to be actually be in a better spot than you were before because of the way that we’re trying to help heal it and the things that we’re trying to do. So, so to me, I I don’t see a downside to doing it because biologically you’re not going to be in a worse spot.
Nicole: Okay. How long until I actually feel results? I don’t have time to wait six months.
Dr. Garg: Yeah. Most people don’t. I mean, I think that’s the that’s we talk about buying back time all the time. And so when we use our combination of shockwave and biologics or are we resetting the nervous system with our dynamic mind plus protocol, whatever you have in that space. I mean I think I think that’s where you speed up recovery. You know there are situations where we’re counting days and and I’ll give you an example. We had a we had a college gymnast who had 10 weeks to prepare and I looked at his MRI on a Tuesday night and I called him and he said, “Do you call all your patients on a Tuesday night?” I said, “No, not really. But I have to figure out how much time I have and to be able to figure out what do I need to get you ready for because if I tell you I’m seeing you next week, then I’ve lost a week.” And so if you only have 10 weeks, then I need to see you tomorrow morning and here’s our plan. And so I think that’s that’s where we look at speed and trying to recover. And I think you know my background just working with USA hockey and US soccer. Same premise that we’re always trying to make sure can we get our people back as quickly and safely. Safely is a really big key here too and and making sure that you feel really good about it. But there’s a lot of things that can be done that can accelerate healing.
Nicole: So are you just going to tell me I’m a candidate so you can take my money?
Dr. Garg: Yeah. No, no. I mean, there’s a guy who walked into our clinic and said, “Here’s [amount]. Can you fix me?” I just looked at him and I said, “Please, won’t anybody take your money?” I I think you need to have surgery here. What I’m going to do here is not going to help you. We can certainly help you before surgery. We can certainly help you after, but I don’t think what we’re going to do is going to fix your problem. So, to the financial detriment of our clinic, I told them, “Please don’t let anybody do this to you.” And so I think that’s really the big thing and we kind of go from there. We’re at 22 and a half minutes here just on the
Dr. Garg: Okay, this my last question.
Dr. Garg: Yep.
Nicole: My primary care doctor and my orthopedic surgeon have never mentioned any of this. Why not?
Dr. Garg: I think it goes back to the original questions that we were started talking about where
Dr. Garg: they just don’t know. I don’t think there’s a deep understanding of regenerative medicine. So, it’s really easy to push that to the side and to say, “Well, that studies show it doesn’t work that well or whatever excuse they may work in their favor, if you will, right?” And so, and I think um I think it just comes down to not not having a deep understanding and knowledge. And I think sometimes when in the past if they’ve read something that PRP doesn’t work again, it could have been a small amount of volume that they took or it could have been without an injection uh protocol in place with ultrasound. So there could have been other factors that yield a really nice headline in a research study that says PRP doesn’t work. And I think that’s where people miss out on that. So yeah, these are great questions and I think I think for those that are listening and if you have these questions and you continue to feel like I don’t know what to do and you’ve got problems that you feel stuck, I mean I would if any of this resonates with you, I would tell you to to go to DynamicAthlete.com and just have a look and see if these things make sense. And certainly happy to help if we can. But hopefully this has been uh enlightening in a way where you now are feeling like you’re more empowered to ask the right questions wherever you go. We’ll see you next time. Thanks.
