April 21, 2014

Hines Ward and His Super Bowl Blood Treatment

Nick Laham / Getty

Nick Laham / Getty

Hines Ward was an integral part of Pittsburgh’s victory in the Super Bowl over the Arizona Cardinals.  This came a couple weeks after the Ravens tried to break him in half on a tackle after a catch.  In that tackle, Ward reportedly sprained his medial collateral ligament and underwent treatment so that he could play in the Super Bowl.  Then, on the broadcast Andrea Kremer talked about Ward’s treatment.  She reported that Ward had some blood drawn, had cells removed, concentrated, and then injected in the affected area of Ward’s knee.  Then the Internet exploded with rumor and speculation.

If it weren’t for the Tour de France, I don’t think anybody would have ever heard of blood doping.  Blood doping is terminology, at least in cycling, that refers to the injection of concentrated blood in a near timeframe to competition in order to boost stamina and aerobic capacity.  In the case of cycling, the practice is desirable to riders because the increase in red blood cells will deliver oxygen to muscles more efficiently, which subsequently should reduce fatigue.  It is this knowledge that probably spurred all the speculation and intrigue with Hines Ward’s procedure on the Internet.

So what do we actually know about Hines Ward’s treatment?

Well, first, a disclaimer.  When it comes to talk of performance-enhancing drugs and procedures I really want to be extra careful.  As a sports writer who has no medical expertise that isn’t provided by Google, it would be irresponsible for me to draw wildly judgmental conclusions. So, while I will tell what I found out and maybe my initial thoughts and opinions, they should be taken as just that.

According to Dr. Allan Mishra, what Hines Ward had was a Platelet Rich Plasma (PRP) treatment.  According to Mishra’s website, the treatment has been used in the past for Major League soccer players.  The thought by many doctors seems to be that this is just the next step in treating injuries and that someday it will be used in orthopedic surgeries from knees and shoulders to the achilles and even chronic tendinitis and “tennis elbow.”  Doesn’t it seem awfully strange that such similar sounding procedures could be completely demonized in one world while making for a feel-good story on the sidelines of the Super Bowl?  What gives?

Just from my amateurish viewpoint, one thing sticks out to me already.  In the world of cycling it sounds as if guys are blood doping to get an edge on the competition.  They aren’t addressing a specific injury.  They are injecting to increase stamina to allow them to compete at a higher level above their opponents. 

Contrast that with Hines Ward who was using his PRP treatment to treat a specific injury in his knee.  He wasn’t using the treatment to make him better than the player who walked onto the field week one of the NFL season.  He was attempting to heal an injury that was threatening to keep him off the field completely.  And while endurance and stamina do matter in an NFL game, it is something that teams are already artificially enhancing on an every-game basis as it is with oxygen masks, right?  It is through this lens that it appears to me that there is a distinction between the treatments.

And what of the treatments?  Are they virtually the same?  While I can draw differences between the potential perceptions of the two treatments, I can’t possibly compare the two from a scientific standpoint with my measly sports-brain.  While I didn’t find anything conclusive, I did get some interesting info from my research and some scientific friends.  Keep in mind, yet again, that these are just theories proposed by me and other people who haven’t produced studies.

It is my understanding that first there are differences between the Red Blood Cells collected from samples for the blood doping practice with the cyclists and the platelets collected for PRP.  The cyclists collect whole Red Blood Cells because they increase the body’s capacity to carry oxygen.  In PRP they are collecting platelets which are responsible for clotting.  It seems that the scientific community would draw distinctions between these two types of plasma (I think.) 

The other important distinction seems to be that cyclists inject their substance directly into their veins, while PRP is injected into the affected area, in Hines Ward’s case, his knee.  This seems like it might be important because the injection into the veins would directly increase the blood stream’s capacity to carry oxygen, while the PRP injection would concentrate the effect directly to an injured area like a tendon or ligament.

So the question becomes, and I couldn’t find a study that stated anything about this, is whether or not the PRP treatments have any effect on aerobic capacity or not beyond the immediately affected area.  Was Hines Ward any more capable to play a full game after his treatment stamina-wise than before the treatment?  That will probably ultimately be the deciding factor in how the sports community looks at this new treatment.  And maybe studies have already been performed and the morality line has already been drawn.  If so, I didn’t find it and I would be happy to hear about it.

But for now, the bottom line can best be described in MythBusters format.  If the question was, “Did Hines Ward cheat by getting a PRP treatment prior to the Super Bowl?” my opinion would be that the answer is “Inconclusive” with a heavy lean toward “Busted” he did not cheat.  Then again, I am just some dude with a computer in Cleveland talking about sports.

  • http://www.twitter.com/dennymayo IRB?

    As a member of the “scientific community”, I’ll say there absolutely is a difference between concentrated RBC plasma and platelet enhanced plasma.

    I think this is legit. That being said, I’m a chemist not a biologist or doctor.

  • http://www.waitingfornextyear.com Craig

    Aren’t you supposed to bring the funny, IRB? That last comment wasn’t funny at all.

    :-)

    Thanks for the info.

  • ryan

    [Comment removed - WFNY]

  • Spaniard

    I don’t condemn the PRP procedure but I also don’t see any fundamental difference between the two treatments. Sure RBC and plasma affect the body in different ways, but both seem to be using blood factors to gain an edge (whether it be in oxygen transportation or healing capacity) over competition. To say that the difference in treatment is in the intentions and specificity also seems misinformed. Many baseball players have admitted to injecting HGH for its healing properties to help rehab from a specific injury. Obviously legal means are used for gaining an edge all the time whether it be by supplements, pain killers, or the aforementioned field oxygen so its just a matter of drawing a line somewhere–probably player safety. Seems like modern medicine is just making it that much more difficult to wipe that stupid smile of Ward’s face.

  • http://www.twitter.com/dennymayo IRB?

    Oh yea, funny… I guess we can say although he’s got the blood doping down, Hines has one ball too many to win the Tour.

  • S-Dub

    Hey guys thanks for clearing that up for me. I wasn’t able to look at the telecast again to see wat she said exactly happened, and at first it sounded like the blood doping thing to me, but if it isn’t then it isn’t . They still shoulda called the TD celebration penalty though!!!

  • bobby

    I dont know if RBCs dan platelets can be seperated, but I also do not know all that much about that procedure. To me, its like the HGH arguement though. Pettite did it to get to the field faster while others did it for a better game. The point is they each took HGH. This sounds like blood doping and doing it to get to the field faster is still blood doping. I dont know if this would be illegal or not in the NFL, or if it would even help, but when I heard this while watching the SuperBowl this is what I immediately thought.

  • meommy89

    Biology Major here
    Platelets do not carry oxygen, and so do not affect the body’s aerobic capacity.
    Platelets are part of the blood clotting process, but i have no idea how they would help improve healing time or reduce the impact of an injury like wards. So yes BUSTED, Ward did not cheat.

    The concentrated red blood cells used for blood doping are entirely different.

  • http://www.waitingfornextyear.com DP

    Didn’t Ward also pull an Anthony Gonzalez and sleep in a hyperberic chamber, as well?

  • http://www.waitingfornextyear.com Craig

    The difference between this procedure and HGH, in my view, are this. HGH will actually make you stronger than you normally would be. It allows you to create a different person who is more than likely unsustainable without continued use.

    This PRP treatment will help heal, but beyond that, I don’t believe it will serve as performance enhancing because it is so localized. That is to say that I don’t think you can give one of these treatments to someone’s entire body.

    Then again if starters start using a treatment like this in baseball after every one of their starts, I think I would feel differently. Either way, it is confusing, but a necessary topic in the modern age of sports.

  • tommyd1022

    I just had this done myself. I’m a 48 year old runner who tore both hamstring muscles and the hamstring tendon. Had PRP done 6 months ago to repair the area. TOTALLY avoided surgery which would have left me in bad shape for a year.

    It was done by a syringe in the doctor’s office and took about 15 minutes. The blood-doping that a cyclist friend talked about has a lot to do with intervenous bags, etc… not even close to this procedure.

  • Boomhauer

    While this sounds legit, it wouldn’t surprise me if the Steelers cheated. The Steel Curtain team of the 70′s should have been called the Steroids Curtain. Is it any wonder why many of them are dying earlier than their NFL contemporaries?
    And yes, I’m a bitter Browns fan.

  • http://psamp.com tecmo

    Boomhauer – Give me facts rather than your opinion. Read about Sid Gillman and the 60s Chargers if you want to hear about steroids. Steve Courson, the only Steeler who admitted using steroids, died from a tree falling on him. Mike Webster had brain damage from concussions. Dwight White died from complications from surgery. Ernie Holmes died in a car accident.

    And even if any of the Steelers were using steroids back then, the drugs weren’t banned, and every other team most likely was doing the same thing.

    (Edited by WFNY – No personal attacks will be tolerated)

  • mj

    Whether or not that’s any different than using, say, HGH to recover from an injury is debatable. But I don’t think what Ward did is at all like the blood doping they talk about in cycling.

    The blood-doping in cycling is similar to what happens to one’s blood at high altitudes. This is why climbers on Everest spend time acclimating at various base camps… to allow the body time to manufacture additional red blood cells to increase capacity to carry more oxygen, which is necessary for survival at altitude where the oxygen concentration in the air drops dramatically. Artificially doing this (such as in blood doping) has obvious benefits to a distance athlete, as it improve their capacity to deliver more oxygen to their muscles. I’m sure the benefit to an NFL player would be debatable, as their activity is more anaerobic than aerobic. It wouldn’t help them get off the line any quicker, or tackle any harder, but it might help them on a 99yd interception or kickoff return.

    But what they’re doing in MLS and the NFL is a local injection into tissue, and would not provide any of the aerobic benefits as they aren’t increasing the number of red cells in the player’s bloodstream.

  • Dean

    It’s important to note though, that the “recovering from an injury” excuse really doesn’t hold water. That’s why most baseball players took steroids, and why Luis Castillo of the Chargers (among many others) was busted before the NFL draft. I’m not saying that blood doping in this context is wrong, but it highlights what a fuzzy line there is between permissible and impermissible methods of speeding recovery.

  • mj

    I agree, Dean. But whether what Ward did was ethical or allowable, it is not the same as blood-doping–an artificial attempt to mimic the body’s response of producing additional red blood cells–which is what I was trying to point out. I type off the top of my head and hit submit before proofreading my comments most times… and don’t mean for my first sentence to read in any way that I’m trying to justify what Ward did. But regardless of what he did, based on what’s been reported, it wasn’t blood doping. Ward’s treatment may ultimately be deemed legitimate medicine or banned as cheating, but it’s not blood doping–they weren’t altering the blood in his body, they removed it and injected it as a treatment (see tommyd’s post above,) which isn’t the same.

  • http://www.waitingfornextyear.com Craig

    One other huge note on this whole thing is that he was apparently not trying to cover it up as it was reported by Andrea Kremer. Blood doping in cycling is something they clearly test for and if you are doing it in that context you are absolutely trying to cheat.

    In this scenario, I think that is a distinction to make too.

  • Dean

    MJ, I agree with you on your take on blood doping (and like the climbing analogy) and I definitely mixed up my terms. I should’ve been more specific to point out that regardless of the method used, the ethical grey area still appears even when the treatment (or doping) is done in response to injury. There is a difference between localized treatments (what you described and what Tommy above had for his hamstrings) and treatments that also have ancillary effects on fitness, but I’m not sure if that distinction covers the ethical issue. Faster recovery from injury is still performance enhancement, as injuries are a major part of all sports.

    Craig brings up the issue of legality (within the sport), which I like because it avoids the ethics debate. While the blood doping ban will need a justification, it’s perfectly ok to have arbitrary rules that must be followed (ie double dribble, no forward passes beyond the line of scrimmage, etc.) that have nothing to do with any larger community ethics.

  • mj

    “Blood doping in cycling is something they clearly test for and if you are doing it in that context you are absolutely trying to cheat.”

    Absolutely. Although Ward wasn’t blood-doping, I wonder if it’s banned by the NFL. I question whether anybody would do it, as it’s benefits are primarily for aerobic capacity, and for a hard-hitting NFL athlete I think the risks would be too great (there is a risk associated with enhanced red cell production… in the form of clotting and/or strokes. I know that is a factor in high altitude acclimation, so am assuming it extends to blood dopers as well–though I could be wrong there.)

  • mj

    @Dean – agree 100%.

  • mj

    By the way, just wanted to offer kudos on an excellent article, Craig. Very good, thought-provoking read.

  • flea

    actually, contrary to popular belief blood doping does not even have any positive effects on the oxygen delivery to tissue. Increasing the RBC count increases the viscosity of the blood. Since the blood is more viscous it is met with more resistance in the arteries and blood flow is slowed. Since blood flow is slowed, so is delivery of oxygen to the tissues. So according to my physiology professor (I’m a graduate pharmacy student) this is a moot point anyway.

    On the other hand, I’m all for taking away any credibility from Pittsburgh so I say he cheated.

  • http://www.waitingfornextyear.com Craig

    Thanks very much, mj.

  • mj

    That’s interesting, Flea. Do you know if blood doping is somehow different from what happens in high altitude acclimation? I assumed it achieved the same effect, perhaps it does not (I’m not a scientist, just familiar with climbing.) Or perhaps there are other factors that make the increased RBC count effective at extreme altitudes, such as reduced pressure?

  • S-Dub

    OH MAN NO LOVE CRAIG FOR THE IDEA!!! haha just kidding!

  • Bridgecrosser

    This thread made me think of this article – a GREAT read that explains some of the blood-doping programs in 90′s cycling. I was able to locate it in the SI Vault.

    Reading this was one of those points where sports wasn’t the same afterwards:

    http://vault.sportsillustrated.cnn.com/vault/article/magazine/MAG1016322/index.htm

  • flea

    mj, i’m pretty sure high altitude acclimation has something to do with the efficiency which blood (RBCs) operates at low partial pressures of oxygen. There is some kind of binding protein (myoglobin or hemoglobin) in blood which facilitates the binding and subsequent exchange of oxygen at the tissues. When you train at high altitudes the protein becomes better at working with lower amounts of oxygen which becomes useful when you are in lower altitudes involved in strenuous activities.

    this might not be exactly right because i took biochem last quarter and i seem to forget things pretty quickly.

    man i feel like a huge nerd posting this on a sports blog

  • ryan

    i got my last comment (#3) from clint eastwood in gran torino! i need to stop watching movies and hating the steelers so much then

  • http://www.twitter.com/dennymayo IRB?

    Flea’s got it right. The increase in hemoglobin’s efficiency in O2 binding at low partial pressures allows it to deliver even more O2 at lower altitude (higher partial pressure of O2). That’s why a lot of the Kenyan runners are extremely efficient – they train in the mountains and when they come down to race their bodies are primed for aerobic exercise.

    Doping via RBC concentration and eventual re-uptake increases the blood’s ability to store O2 by increasing the concentration of RBC’s in the blood. Doping via erthyropoietin increases the body’s production of red blood cells, which effectively does the same thing. However, is detectable because of post-translational modifications of the naturally occuring hormone in the body (synthetic EPO doesn’t have these modifications, giving it away) and so this method has gone by the wayside for most intents and purposes.

    When I was in high school a few of us tried to convince our anatomy teacher that we should get EPO and use it in the weeks leading up to state track in order to get an edge since nobody tests in high school. Sadly(?), it didn’t happen.

    Tommyd – you running the Cleveland marathon in May? I’ll be there, aiming for 3:35-3:40. It’ll be my second marathon, after Columbus 07.

  • http://www.twitter.com/dennymayo IRB?

    PS this website needs more science, this post really gets my blood pumping! (yuk, yuk)

  • http://none Silent Majority

    This was BLOOD DOPING, simple as that. Ridiculous that American sports have no real rules about cheating. Cycling gets a bad rap, but at least they are trying to hold the athletes to standards.

  • http://www.waitingfornextyear.com RockKing

    I thought we were supposed to be more funny, not more scientific.

    Oh, wait, science IS funny! :)

  • flea

    IRB, did you read my first post (22)? I was under the impression that if blood doping was to be feasible it would work by increasing hemoglobin’s efficency not by increasing the number of RBC. Any thoughts? Maybe I’m just missing something.

  • http://www.twitter.com/dennymayo IRB?

    Flea – I don’t know much about the physiology of it so I’d say your prof has more credibility that I do. All I know is that EPO has been used to blood dope, and it directly effects the RBC count in blood. There’s also been plenty of cases where the blood is centrifuged, the RBCs separated, cooled, and later reinjected to the athlete to give a supposed edge.

    Whether this indeed does increase blood viscosity and slow delivery of O2 to cells, I don’t know but that makes sense from a common sense standpoint.

    Half the time it’s a mental edge that’s gained and that’s it. High altitude training works because it increases O2 binding efficiency. That’s a definite. Everything else I’m not 100% sure on. We need a physical therapist or a physiologist to enlighten us.

    @ Rock – Science is funny. Ever watch Bill Nye?

  • dblup21

    Okay I want to touch on the blood doping thing a bit, I have my masters in exercise physiology so I do have a little background with this, I am also a Certified Atletic Trainer, so I can speak on the medical aspect as well.

    First, the reason blood doping is effective is because it does increase the RBC count, thus increasing the oxygen carrying capacity of the blood. Hemoglobin is present only in RBCs, you increase the RBCs and you increase the oxygen carrying capacity of the blood. Hemoglobin does not become more “efficent” it is a chemical reaction that is dependent on O2/CO2 saturation of the blood and tissue. Flea, maybe your professor has access to some research I haven’t seen, but I haven’t come across anything showing that hemoglobin/myoglobin become more efficient.

    As to whether this is doping, absolutely not! This treatment would be similar to using cortisone to cause inflammation to faciliate healing. The only difference is that we are using the body’s own inflammation causing substances that naturally occur in platlets and WBCs. When the platlets are exposed to an area of tissue damage, they release protiens that increase inflammation, the WBCs on the otherhand destroy the damaged tissue to allow healing to occur (phagocytosis). This isn’t cheating by anymeans, just a new take on an old treatment.

  • http://www.twitter.com/dennymayo IRB?

    Touche salesman. Thanks for the insight.

  • mj

    More interesting stuff here.

    @dblup21 – thanks for clarifying. I thought that was the case, but my background is accounting/finance and not science, so I only have a layman’s understanding.

  • http://concellcorp.com Jeff Soule

    Doping? The use of PRP and APG as a tissue healing methodology has been around for over ten years – it just hasn’t gotten much press. I’ve been supplying a PRP procurement service for plastic, oral/maxillofacial and periodontal surgeons since 1996.

    Here’s the deal, everyone’s blood is made of the same elemental components: red blood cells (RBCs), clotting factors, platelets, and plasma – the fluid in which the other components are transported throughout the body. Each component has its role: RBCs carry oxygen, clotting factors help us stop bleeding and platelets help us heal faster as well as help reduce bleeding. At an injury site, platelets begin the healing process by releasing special proteins, called growth factors, into the wound. Stimulated by these growth factors, cells begin to divide and multiply while, simultaneously, new blood vessels forge their way into the site. These new vessels will carry vital nutrients and oxygen to nourish the growing tissue whether bone, ligament, muscle or skin. Autologous platelet gel (APG) is a coagulum formed when a platelet-rich concentrate is encouraged to “gel” by the addition of a clotting agent, such as thrombin.

    At the point of care, whole blood is removed from the patient in a method similar to a normal blood specimen collection. Next, the platelet-rich plasma, or PRP, is separated from the other components by centrifugation, and placed in the sterile field (The best PRP separator has automatic sensors to detect where the platelet pack is and when to extract it – the key to high concentration). The doctor then injects this PRP into an injury site or adds it to bone or skin graft as a tissue healing accelerant. In soft tissue wound care applications, PRP is encouraged to clot by the addition of thrombin, a common blood clotting agent. The APG is then placed on the wound or ulcer and covered with a dressing. Suspended in the resultant autologous platelet-gel (APG) is a concentrated supply of growth factors like platelet derived growth factor (PDGF), transforming growth factor-beta (TGF-β) and vascular endothelial growth factor (VEGF) – all of which are naturally found in everyone’s blood. These platelet-derived growth factors heal us even at normal levels. But 6, 8, 10 or even 14 times baseline, tissue regeration is accelerated.

    I believe it will be the standard of care for many wounds and injuries, and PRP should not be associated with performance enhancers, steroids or cheating.

    Jeff Soule
    Dir of Operations
    Con Cell Corp
    Cell: 203-232-5962 – Off: 845-878-7711
    j.soule@concellcorp.com