Is low leukocyte (white blood cell) platelet-rich plasma (PRP) or high leukocyte (white blood cell) platelet-rich plasma (PRP) more effective for treating muscle spasms?

Low Leukocyte PRP is Preferable for Treating Muscle Spasms

Low leukocyte platelet-rich plasma (PRP) is more effective than high leukocyte PRP for treating muscle spasms, as it provides better muscle regeneration with less inflammatory response.

Understanding PRP Classification

According to the International Society on Thrombosis and Haemostasis (ISTH) guidelines, PRP preparations are classified based on their leukocyte content 1:

• PRP: Low leukocyte content (<1% of total cells)
• L-PRP: High leukocyte content (≥1% of total cells)

The ISTH emphasizes that reporting the purity of PRP preparations is essential, including the concentration of white blood cells, as this significantly affects clinical outcomes 1.

Mechanism of Action in Muscle Healing

PRP works through several mechanisms in muscle tissue:

• Delivers growth factors that promote tissue healing
• Stimulates angiogenesis (new blood vessel formation)
• Enhances myocyte proliferation and differentiation
• Reduces fibrosis during healing

Impact of Leukocyte Content

The leukocyte content in PRP significantly impacts these mechanisms:

1. Low leukocyte PRP:

   • Promotes better muscle regeneration
   • Creates less inflammatory response
   • Results in less fibrosis
   • Better supports neovascularization 2

2. High leukocyte PRP:

   • Causes greater inflammatory response
   • May delay healing in some muscle injuries
   • Can increase pain and swelling
   • May contribute to greater fibrosis formation

Evidence Supporting Low Leukocyte PRP

Research indicates that PRP concentration affects muscle regeneration in a dose-dependent manner, with better outcomes observed in properly prepared PRP with controlled leukocyte content 2. Studies examining muscle injuries have found:

• Better muscle regeneration with low leukocyte PRP
• Increased neovascularization
• Slight reduction in fibrosis compared to controls 2

Clinical Application for Muscle Spasms

For muscle spasms specifically:

1. Preparation matters: The ISTH guidelines emphasize reporting the purity of PRP preparations, including white blood cell content 1

2. Delivery protocol:

   • Direct injection into the affected muscle
   • Typically a single injection, though protocols vary
   • Volume depends on the size of the affected muscle

3. Expected outcomes:

   • Reduced inflammation
   • Decreased pain
   • Faster recovery time
   • Improved muscle function

Limitations and Considerations

Despite promising biological rationale, there are important caveats:

• High-quality randomized controlled trials show mixed results for PRP in muscle injuries 3
• The ISTH guidelines note uncertainty about PRP use for acute muscle injuries (median score of 5; range of 5–6) 1
• Significant heterogeneity exists in PRP preparation methods, making direct comparisons difficult 4
• Optimal platelet concentration, leukocyte content, and treatment protocols remain areas of ongoing research 4

Practical Recommendation

When treating muscle spasms with PRP:

1. Choose low leukocyte PRP preparations
2. Ensure proper preparation and quality control of the PRP
3. Document baseline platelet concentration and white blood cell content
4. Consider the activation method (if any) before administration
5. Monitor for clinical improvement and adjust treatment as needed

While the evidence quality is still developing, the available data suggests that low leukocyte PRP offers the best balance of regenerative potential with minimal inflammatory side effects for treating muscle spasms.