Sixteen minutes down I-270, and usually the second opinion.

I-270 SOUTH TOWARD I-64

Creve Coeur is about sixteen minutes and nine miles from us. It sends us the most well-researched patients we see, which changes the shape of the appointment.

Getting here

Up Lindbergh or across on Olive and Natural Bridge. Surface parking at the door, ground floor, full-size elevator.

When you have already read everything

A lot of people arriving from this corridor have read the trials, or the summaries of them, and arrive with a specific question rather than a general complaint. That is welcome, and it means we can skip the introductory part and get to the disagreement.

The disagreement is usually about how to read a literature that looks inconsistent. Four things explain most of that inconsistency, and knowing them makes the published evidence far more legible.

• Follow-up length decides the winner. A trial that stops at eight weeks reports corticosteroid superior; the same trial at twelve months reports the reverse.
• PRP is not a standardized product. Platelet concentration varies several-fold, leukocyte content is often unreported, and preparation methods differ enough that pooled analyses average across different interventions.
• The control arm is rarely inert. A saline injection into a degenerate tendon still involves needle fenestration, which is itself therapeutic. Trials comparing PRP to saline often compare two active treatments.
• Exclusion criteria remove the patients who actually present. Diabetes, higher BMI, inflammatory disease and multiple painful sites are routinely excluded.

That last one is the most consequential and it is expanded on the coverage page, because it is also why your insurer will not pay for this.

The sedentary-professional pattern

Desk work produces a recognizable set of problems, and they are not the ones people expect from a job that involves sitting down.

Prolonged sitting deconditions the gluteal complex and shortens hip flexors. Weak abductors let the pelvis drop and the hip adduct with every step, which compresses the gluteal tendons against the greater trochanter — the mechanism behind most lateral hip pain. Meanwhile the metabolic consequences of low incidental movement accumulate silently for years: insulin sensitivity drifts, visceral adiposity rises, and inflammatory tone with it.

Then a weekend of tennis, or a return to running, asks tissue that has been quietly degrading to perform. The injury looks acute and is not.

What we treat

• Gluteal tendinopathy — the compression mechanism, and what makes it worse
• Tennis elbow — and why it is not an inflammation
• Achilles tendinopathy
• Knee osteoarthritis
• Hip osteoarthritis
• Rotator cuff tendinopathy
• Plantar fasciitis

On stem cells, since it is the most common question here

The phrase covers four quite different things, and only one of them is what most people picture. Culture-expanded stem cells are not legally available as a routine treatment in the United States outside an approved trial. What American clinics generally mean is bone marrow aspirate concentrate, in which mesenchymal stromal cells are well under one percent of nucleated cells.

Products sold as umbilical or amniotic stem cell injections deserve particular caution: independent testing has repeatedly found few or no living cells in commercial samples, and they are frequently the most expensive item on a clinic’s menu.

The full explanation, including what would change our position, and how PRP and BMAC actually compare — including the infection-risk difference that changes whether antibiotics are appropriate.

What we will not tell you

Worth stating explicitly for an audience that will check.

• That PRP regrows cartilage. Nothing available reliably does.
• That it works for everyone — a meaningful minority get nothing, and that figure belongs in the conversation before treatment rather than after.
• That results arrive quickly. Six weeks for a signal, three months for an answer.
• That it substitutes for an operation you genuinely need.
• That we will bill your insurance. We do not; this is a self-pay practice.

How we decide, and when we decline

Four questions in order: is the tissue the kind that responds, what stage is it at, what metabolic terrain is the repair running in, and what are you expecting. A poor answer to any one of them can be decisive on its own.

We decline more often than a clinic that sells a single product does. End-stage structural disease is a conversation about what treatment can and cannot do — time and medication burden, not restored structure — and sometimes about a surgeon. An unclear diagnosis needs resolving before anything is injected. A conservative trial that has not genuinely happened means you may be paying for a recovery you would have had anyway. And uncontrolled diabetes is a reason to sequence treatment rather than refuse it — treat the terrain, then the tendon.

The candidacy page sets all of this out, including the questions worth asking any clinic, this one included.

The metabolic argument, in one paragraph

Chronic pain, obesity, addiction and type 2 diabetes are treated here as one collision of epidemics running on a shared engine rather than four specialties’ separate problems. Metabolic inflammation, insulin resistance and disrupted reward signaling appear in all four, and a tendon that will not heal in a person whose A1C has been drifting for a decade is not a coincidence of two conditions.

The practical consequence for you is that a metabolic panel is part of planning a joint injection here rather than a separate concern for a different doctor, and that behavioral and metabolic work is roughly 40 to 50 percent of the protocol rather than advice attached to the end of a procedure. Acceptance and Commitment Therapy is delivered in-house by a licensed pain-trained clinician, not referred out.

Why the practice is organized that way — including the two decades Dr. Padda spent treating pain as a purely local mechanical problem before concluding publicly that he had been wrong about it.

Reading a clinic, including this one

Six questions worth asking anywhere that offers regenerative treatment. They are not hostile; they are the ones a clinic confident in its own reasoning will answer without hesitation.

• What specifically do you think is generating my pain, and how do you know?
• What is the realistic chance this helps someone at my stage with my metabolic picture?
• Will the injection be image-guided, and if not, why not?
• What is the loading program afterward, and who supervises it?
• At what point would you tell me this has not worked?
• What would you do if this were your shoulder?

A clinic that cannot answer the fifth is not planning to tell you when to stop.

What people from Creve Coeur ask

I have read the trials. Why is the evidence so mixed?

Mostly follow-up length, preparation heterogeneity and non-inert controls. And who gets excluded.

Is BMAC better than PRP?

Not demonstrably in knee arthritis at a year, and it is more invasive and costlier. The comparison.

My hip hurts on the outside when I sleep on it.

That is usually gluteal tendinopathy, and stretching it makes it worse. Why.

What would make you say no?

An unclear diagnosis, or a conservative trial that has not happened. Candidacy.

Related reading

• Areas we serve
• How PRP works
• Information for referring physicians
• About Dr. Padda