Lee's abdomen treated via injections

PEORIA, Ariz. -- This is one unusual experiment for Cliff Lee and the Seattle Mariners. Any major league team, for that matter.

Lee is sidelined with a strained abdomen that could cause him to miss the first weeks of the season, but the Mariners are using platelet-rich plasma injection therapy to treat their prized winter acquisition.

The treatment for the 2008 AL Cy Young Award winner has been used for the last decade mainly on joint issues such as tennis elbow, hamstring strains or other injuries to limbs.

Not on abdomens. That makes Lee something of a medical experiment.

"I guess you'd have to say that," Mariners medical director Dr. Ed Khalfayan said Saturday in a telephone interview from his home in the Seattle area.

Khalfayan gave the 31-year-old left-hander an ultrasound and the platelet-rich plasma therapy on March 19 in Seattle, injecting Lee's own blood into the injured area to focus its healing powers on his ailing midsection.

Khalfayan doesn't like the negative connotation that comes with the term "experimental." But he agrees what the Mariners are doing with Lee remains largely unproven.

"It hasn't gotten to the point that it's accepted, standard practice," Khalfayan said of the therapy.

He said the only risk is a small one of infection, as with any injection, and is far less than the risk of injecting drugs such as cortisone.

Lee said he felt markedly better three days after the injection, but he had pain throwing for five minutes on flat ground on Tuesday and Thursday. He won't throw again until at least Wednesday, making it likely he will begin the season on the disabled list.

This is Lee's third strained abdominal muscle since 2003. The other two injuries also happened in spring training when he was with Cleveland and put Lee out for at least six weeks.

The Mariners are hoping this new idea reduces that recovery time.

"I'm fairly new to this platelet-injection stuff. It's pretty wild to me," manager Don Wakamatsu said. "It looks like there's been great results with it. We're trying to be optimistic."

And cutting-edge.

Dr. Allan Mishra, an orthopedic surgeon at Stanford University Medical Center, is one of the pioneering researchers of platelet-rich plasma injection therapy. He knows of only one study on PRP with abdominal strains, on a handful of soccer players in Europe. The results were inconclusive.

"Those types of injuries can take a fair amount of time," Mishra said in a phone interview. "And the PRP data for that is pretty nonexistent."

The therapy was introduced in the 1970s for surgical uses in hospitals. It didn't enter sports medicine until a decade ago. In the 30-minute procedure, a tube of a patient's blood is put in a centrifuge and spun, producing concentrated platelets. The platelets contain growth factors that accelerate tissue repair and regeneration. The platelets then are injected into the injury site.

The treatment gained notice in 2008 after Pittsburgh receiver Hines Ward used it on his sprained right knee to help him play in the Steelers' Super Bowl win over Arizona.

PRP is gaining popularity among injured "weekend warriors" and their insurers because its $2,000 cost is a fraction of that for potential surgeries.

Mishra said because PRP has been used in sports medicine for only eight or nine years, doctors are still learning what injuries respond to the therapy.

"I never had a vision it would work for all types of problems," Mishra said. "But athletes teach us how to use these techniques.

"It will be interesting to see when [Lee] does return to pitching. ... I appreciate athletes pushing us."

Pitcher Takashi Saito avoided surgery on a partially torn ligament in his right elbow by using PRP therapy during the 2008 season. He came back to help the Los Angeles Dodgers win the NL West.

Khalfayan has been the team physician of the NFL's Seattle Seahawks since 1996. He used PRP injections last season on muscle strains, particularly hamstrings. He said he was successful in getting Seahawks back on the field sooner than they would have with more orthodox treatments such as cortisone shots.

He said the use of PRP on muscle strains is a carryover from its initial uses for arthritic joints and damaged tendons.

"The nature of [Lee's] injury makes you think of using it," Khalfayan said. "It's a strain, and PRP has been shown to help recovery of strains."

It doesn't always work. Former Yankees outfielder Xavier Nady tried PRP treatments last year but still ended up having elbow ligament-replacement surgery. Nady is now trying to come back with the Cubs.

The Mariners consider Lee's injury an isolated, acute one, despite his history of abdominal strains, so they believe he only needs one PRP injection. They said this injury is not related because it is in a different place -- low right, on his belt line -- and was the result of a specific incident. Lee collided with Arizona's Chris Snyder on March 15 while the pitcher was backing up the plate on a scoring play.

Khalfayan thinks with rest, Lee may be pitching for Seattle sooner rather than later.

"I'm optimistic," he said.