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

I-270 SOUTH TOWARD I-64

Creve Coeur patients reach our PRP and orthobiologic injections in about sixteen minutes and nine miles. Many come for a second opinion after reading the trials. Desk work here leads to gluteal tendinopathy, tennis elbow, Achilles tendinopathy, knee and hip osteoarthritis, rotator cuff tendinopathy and plantar fasciitis.

Creve Coeur is about sixteen minutes and nine miles from us. It sends us the best-read patients we see. That 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.

How should you read the PRP research?

Many people from this corridor have read the trials, or summaries of them. They come with a specific question, not a general complaint. That is welcome. It means we can skip the basics and get to the disagreement.

The disagreement is usually about how to read research that looks inconsistent. Four things explain most of that. Knowing them makes the published evidence far easier to read.

• Follow-up length decides the winner. A trial that stops at eight weeks reports corticosteroid as better. The same trial at twelve months reports the reverse.
• PRP is not a standardized product. Platelet levels vary several-fold. Leukocyte (white blood cell) content often goes unreported. Preparation methods differ so much that pooled analyses average across different treatments.
• The control arm is rarely inert. A saline injection into a degenerated tendon still involves needle fenestration (small needle punctures), which is itself a treatment. Trials comparing PRP to saline often compare two active treatments.
• Exclusion criteria remove the patients who actually show up. Diabetes, higher BMI, inflammatory disease and multiple painful sites are routinely excluded.

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

Why does desk work cause hip and tendon pain?

Desk work produces a familiar set of problems. They are not the ones people expect from a job spent sitting down.

Long sitting weakens the gluteal muscles and shortens the hip flexors. Weak abductors (the side hip muscles) let the pelvis drop and the hip swing inward with every step. That presses the gluteal tendons against the greater trochanter (the bony point of the hip). It is the mechanism behind most lateral (outer) hip pain. Meanwhile, the metabolic cost of little everyday movement builds quietly for years. Insulin sensitivity drifts. Visceral adiposity (fat packed around the organs) rises, and inflammatory tone rises with it.

Then a weekend of tennis, or a return to running, asks tissue that has been quietly breaking down to perform. The injury looks acute (sudden) 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

What do clinics mean by stem cell injections?

The phrase covers four quite different things. 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 usually mean is bone marrow aspirate concentrate. In it, mesenchymal stromal cells are well under one percent of nucleated cells.

Products sold as umbilical or amniotic stem cell injections call for special caution. Independent testing has repeatedly found few or no living cells in commercial samples. They are often 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.

Which PRP claims should you not believe?

Worth saying plainly for readers who 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, not after.
• That results arrive quickly. Six weeks for a signal, three months for an answer.
• That it replaces an operation you truly need.
• That we will bill your insurance. We do not; this is a self-pay practice.

Who is a good candidate for PRP?

Four questions, in order. Is the tissue the kind that responds? What stage is it at? What metabolic terrain is the repair running in? What are you expecting? A poor answer to any one of them can decide it on its own.

We turn people down more often than a clinic that sells a single product does. End-stage structural disease is a talk about what treatment can and cannot do: time and medication burden, not restored structure. Sometimes it is a talk about a surgeon. An unclear diagnosis needs to be worked out before anything is injected. If a conservative trial has not truly happened, you may be paying for a recovery you would have had anyway. And uncontrolled diabetes is a reason to sequence treatment, not 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

Here, chronic pain, obesity, addiction and type 2 diabetes are treated as one collision of epidemics running on a shared engine. They are not four specialties’ separate problems. Metabolic inflammation, insulin resistance and broken reward signaling show up in all four. A tendon that will not heal, in a person whose A1C has been drifting for a decade, is not a coincidence of two conditions.

Here is what that means for you. A metabolic panel is part of planning a joint injection here. It is not a separate concern for a different doctor. Behavioral and metabolic work is roughly 40 to 50 percent of the protocol. It is not advice tacked onto 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. That includes the two decades Dr. Gurpreet Singh Padda, MD, MBA, MHP spent treating pain as a purely local mechanical problem, before saying in public 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. A clinic sure of its own reasoning will answer them without pausing.

• What specifically do you think is generating my pain, and how do you know?
• What is the real 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.

Frequently asked questions from Creve Coeur

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

Mostly follow-up length, mixed preparations and controls that are not inert. And who gets excluded.

Is BMAC better than PRP?

Not demonstrably in knee arthritis at a year. It is also more invasive and costs more. 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.

Will insurance pay for PRP shots?

No. We do not bill insurance; this is a self-pay practice. Part of the reason insurers say no sits inside the trials themselves. Diabetes, higher BMI, inflammatory disease and multiple painful sites are routinely excluded. So the published evidence often leaves out the patients who actually show up. The coverage page expands on that point and on what it means for you.

How long does it take for PRP to work?

Six weeks for a signal and three months for an answer. Timing also explains some of the research. A trial that stops at eight weeks can report cortisone ahead. The same trial at twelve months reports the reverse. It is fair to ask any clinic, this one included, at what point it would tell you the treatment has not worked.

What is the downside of PRP injections?

It does not regrow cartilage, and nothing available reliably does. A meaningful minority of patients get nothing from it. Results are slow. It does not replace an operation you truly need. In end-stage structural disease it offers time and a lower medication burden, not restored structure. Sometimes the right next step is a surgeon.

Related reading

• Areas we serve
• How PRP works
• Information for referring physicians
• About Dr. Padda
• PRP in Olivette, MO