523 ISSN 1758-1869 10.2217/PMT.11.56 © 2011 Future Medicine Ltd Pain Manage. (2011) 1(6), 523–532 SUMMARY There is considerable interest amongst clinicians and researchers to create the optimal platelet product to maximize outcomes with platelet-rich plasma (PRP) injections. PRP has been widely introduced as a safe alternative for treating tendinopathies. However, there is still limited clinical evidence describing the components of the platelet product and supporting its use in clinical trials. This article reviews the current literature regarding the role of PRP injections in the treatment of recalcitrant tendinopathies and the diferent factors in the platelet product that could afect the outcome, including the platelet count, presence of leukocytes, activators used, pH of solution and delivery method, among others. In addition, we address important concepts regarding rehabilitation after PRP procedures, which has little consensus to date and is the subject of much debate. Based on the phases of soft tissue healing, basic science research on platelets, as well as our clinical experience in treating over 500 patients with PRP, we will suggest guidelines regarding the optimal progression of rehabilitation and timing for return to previous activity following the procedure. 1 Department of Physical Medicine & Rehabilitation & Department of Orthopedics, Emory University, Atlanta, GA, USA 2 Department of Physical Medicine & Rehabilitation, University of Medicine & Dentistry, 30 Bergen Street, Newark, NJ, USA † Author for correspondence: ken.mautner@emoryhealthcare.org  There are many factors to consider in preparation and delivery of platelet-rich plasma (PRP) to obtain the optimum platelet product.  Current evidence suggests that higher platelet counts with leukocytes and a slightly acidic pH injected under ultrasound guidance may be ideal to facilitate the healing of tendons following PRP injections.  There is no consensus on rehabilitation after PRP injection, but a protocol that progressively increases the load and activity on a tendon which can augment the tissue healing cascade seems appropriate.  Further research is needed in many areas pertaining to PRP to ind the most efective ways to utilize this technology. Practice Points Optimization of ingredients, procedures and rehabilitation for platelet-rich plasma injections for chronic tendinopathy MANAGEMENT PERSPECTIVE Kenneth Mautner †1 , Gerard Malanga 2 & Ricardo Colberg 1 Historically, the treatment of tendinopathy, whether acute or chronic, has focused on treat- ing perceived inflammation of a tendon and its surrounding sheath. These treatments have included anti-inflammatory medications, ice, and immobilization, usually followed by stretch- ing and strengthening activities once pain had lessened. Often, those who were considered cured (because their pain lessened) found that, when they returned to sports, there was residual structural weakness of the involved tendon and often recurrent pain developed. This concept is illustrated in Figure 1. Histological studies have revealed that these tendons are composed of degenerated collagen, fibrosis, neovessels and, most importantly, a For reprint orders, please contact: reprints@futuremedicine.com