From Injury to Performance: Applying Biologics into Chiropractic Care for Athletes

Webinar highlight from a March educational session featuring Kevin Pierce, DC, DACBSP & Ariana DeMers, DO, RMSK | APEX Biologix Resource Library

Expanding the Continuum of Care in Athletes

Autologous biologics are increasingly being explored as part of a broader strategy in musculoskeletal care, particularly for athletes navigating the space between rehabilitation and surgical intervention.

As introduced in this educational session, the discussion centers on how clinicians may expand treatment pathways to better support recovery, performance, and long-term tissue health.

Rather than replacing existing approaches, biologics may serve as an additional layer within a comprehensive care model particularly when tissue healing becomes the limiting factor.

Integrated, Performance-Based Athlete Care

At advanced performance centers, care is structured around a fully integrated model.

This includes collaboration across:

• Rehabilitation specialists
• Performance staff
• Medical providers
• Imaging and diagnostics

Athletes may move fluidly between evaluation, treatment, and performance training within the same environment, allowing for more coordinated and responsive care delivery.

The Role of Biologics in Musculoskeletal Treatment

Autologous biologics may be considered when traditional care alone does not fully address tissue healing limitations.

This includes scenarios where:

• Rehabilitation progress has plateaued
• Symptoms persist despite conservative care
• Surgery is not immediately indicated

“It’s not about becoming something different, it’s about filling the biggest gap in your current model.”

Patient Selection and Clinical Considerations for PRP

Clinical decision-making for PRP requires a structured evaluation of multiple factors:

Common considerations include:

• Chronic tendinopathies (Achilles, patellar, lateral epicondyle)
• Mild to moderate ligament injury
• Early joint degeneration
• Select muscle injuries (emerging evidence)

Key patient variables:

• Age and healing capacity
• Tissue quality (partial vs complete injury)
• Functional goals and return-to-sport timelines

PRP is generally not appropriate where structural repair is required, such as complete ruptures or surgical indications.

PRP in Practice: Ultrasound-Guided Injection

Ultrasound-guided delivery allows for:

• Real-time visualization
• Improved injection accuracy
• Targeted placement within joint or soft tissue structures

As demonstrated in the webinar, imaging plays a central role in both diagnosis and procedural execution.

In this segment, ultrasound guidance is utilized to support precise biologic delivery, allowing clinicians to visualize target structures in real time and align injection technique with both tissue characteristics and procedural intent.

Complex Knee Injury Case Application

A complex case presented in this session highlights how biologics may be incorporated across multiple phases of care.

Clinical presentation included:

• ACL tear
• Meniscal injury
• Cartilage damage
• Subchondral involvement

Intervention strategy:

• Surgical reconstruction
• PRP used intraoperatively
• Progressive rehabilitation program

Biologics were introduced at multiple timepoints to support both early healing and later-stage recovery.

Rehabilitation and Biologic Integration

Rehabilitation remains central to outcome success, with biologics serving as a supportive component, not a replacement.

Key elements included:

• Progressive loading strategies
• Limb symmetry tracking
• Neuromuscular control development
• Performance-based progression metrics

This integrated approach allows clinicians to align tissue healing with functional demand over time.

PRP + Hyaluronic Acid Injection Strategy

In a highlighted case during the webinar, PRP was combined with hyaluronic acid to support:

• Joint environment optimization
• Symptom management
• Continued functional progression

This approach was selected based on the athlete’s ongoing symptoms and performance goals.

Return to Performance in Athletic Care

A key distinction emphasized in the webinar is the difference between returning to sport and returning to performance.

• Return to sport: Ability to participate
• Return to performance: Ability to meet sport-specific demands

For high-demand athletes, recovery must support:

• Repetitive load tolerance
• Force absorption
• Performance consistency

Biologics may play a role in supporting this transition by improving tissue readiness under load.