Being told you are not a candidate is the point of asking.

CANDIDACY

You are a strong PRP candidate when four things line up. First, tissue that can still repair, such as a degenerative tendon. Second, symptoms past three to six months after a real rehab attempt. Third, a terrain of controlled blood sugar, no nicotine and decent sleep. Fourth, you expect better function in three months, not regrown cartilage.

The useful question is not whether PRP works. It is whether it is likely to work for your tissue, in your body, given what you have already tried. Those are different questions. Only the second one is worth your money.

Who is a good candidate for PRP injections?

Candidacy comes down to tissue, stage, terrain and expectation. A strong candidate passes all four. A poor candidate usually fails one so badly that the others do not matter.

One — is the tissue the kind that responds?

PRP works by restarting a stalled repair. That means there has to be a repair to restart. A degenerative tendon is the classic case: messy collagen, failed healing and new blood vessels growing in. That is why tendinopathy (tendon disease) generally does better than arthritis.

Here is where the case is weaker. Articular cartilage (the smooth joint surface) has no real ability to repair itself at all. A fully ruptured tendon is a mechanical problem. And pain that comes from a nerve, not the tissue, leaves nothing to heal in the place that hurts.

Two — what stage are you at?

Stage matters more than almost anything else. It cuts two ways.

• Too early. Most tendinopathy (tendon pain) and most plantar heel pain clear up with loading, time and less stress on the area. If you inject before a real trial of conservative care, you may pay for something you did not need.
• The window. Symptoms past three to six months. A real rehab attempt behind you. Imaging that shows degeneration (breakdown) rather than a rupture.
• Too late. Large tears where the tendon has pulled back, or hoping to rebuild a joint that no longer has the structure. The problem has become structural, and biology does not fix structure.

Three — what terrain is the repair running in?

Most clinics skip this part. It is also the part that quietly changes outcomes the most. An injection calls up a healing process. That process runs on the raw materials and conditions your body gives it.

• Glycemic control. Sugar-coated (glycated) collagen is stiffer and fails sooner. Poorly controlled diabetes is the strongest factor you can change that predicts a disappointing result. It is a reason to plan the order of treatment, not to refuse it.
• Insulin resistance and visceral adiposity. These keep the whole body in an inflammatory state. That keeps tissue in a breaking-down mode rather than a building mode.
• Smoking and nicotine. Nicotine narrows blood vessels (vasoconstriction) in tissue whose problem is already poor blood flow.
• Sleep. Most repair signals happen overnight. Broken sleep measurably raises inflammation.
• Thyroid, vitamin D and inflammatory disease. Each one changes tendon healing. Each one is worth knowing about before, not after.

None of these is a moral matter, and none of them is a refusal. They change the odds and they change the order. You have a right to know about them before you decide.

Four — what are you expecting?

Someone who expects cartilage to regrow, or relief next week, will be let down by a treatment that is working. Someone who hopes to climb stairs without planning the route, three months from now, is asking it the right question.

We have that talk before treatment, not after.

Who should not get PRP injections?

• Active infection at or near the target site
• Active malignancy, depending on type and treatment status
• Significant thrombocytopenia (low platelets) or a platelet function disorder — the treatment is made of your platelets
• Certain blood thinner (anticoagulation) situations, which need a one-on-one talk rather than a rule
• Pregnancy, on the general rule of not doing elective procedures

When should you wait before getting PRP?

• Uncontrolled diabetes — treat the terrain, then the tendon
• A conservative trial that has not genuinely happened
• An unclear diagnosis, where imaging and the exam disagree
• An untreated neck (cervical) or low back (lumbar) source driving what looks like arm or leg pain
• Active nicotine use, where stopping first materially improves the odds

What happens at a PRP candidacy evaluation?

A history that covers what you do all day, not only where it hurts. An exam that checks the joint above and below, because arm and leg pain often comes from somewhere else (referred pain). A review of your imaging next to that exam, not in place of it. Ultrasound in the room when it will change the answer. And a metabolic panel, because the questions in section three cannot be answered by looking at you.

That process may point somewhere other than an injection — to a nerve, a neck, a rheumatological cause, or a surgical opinion. If so, you will be told. That happens often enough that it should be part of what you pay for.

Questions worth asking any clinic, including this one

• What exactly do you think is causing my pain, and how do you know?
• What is the real chance this helps someone with my stage and 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 question is not planning to tell you when to stop.

The two mistakes that send people to the wrong treatment

The first mistake is treating the scan. Scan findings are common in people with no pain. Disc bulges, rotator cuff tears, meniscal degeneration and heel spurs all show up at high rates in people with no symptoms at all. A report describes anatomy. It does not explain pain. The gap between the two is where a lot of needless treatment happens. If the exam does not agree with the scan, the exam usually wins.

The second mistake is treating the loudest site. Picture someone with a painful shoulder, an aching knee, poor sleep and a rising A1C. That person does not have four unrelated problems that happen to line up. Chasing the loudest one with a needle brings a string of partial wins. Slowly, the patient decides nothing works. It is more useful, and costs less, to ask why several tissues are failing at once.

That is not an argument against treating the shoulder. It is an argument for treating the shoulder and the reason it failed, in the same plan. That is what the metabolic assessment is for.

Can you get PRP if you take opioids?

A candidacy note for anyone on opioids now: taking them does not rule you out here. You will not be asked to taper as a condition of treatment. That approach makes people hide what they take, which is worse for everyone. What we will do is aim at restoring function, because that is what changes the dose question in time. And we will be honest if we think a regenerative option is unlikely to touch what drives your pain.

What people ask before booking

I have arthritis in several joints. Is PRP still worth considering?

Sometimes. But several joints hurting at once often points to a body-wide driver worth treating alongside. Why trials rarely include patients like this.

I am diabetic. Will you refuse to treat me?

No. We are likely to recommend an order of steps, and to be clear about how control affects your odds. How PRP works. What diabetes does to tendon healing, stated honestly.

Do I need an MRI first?

Not always. Ultrasound answers many tendon questions better, and right in the room. What to expect.

What if you tell me I am not a candidate?

Then you leave with a plan that does not involve us. That is a fair outcome of an assessment. Contact us.

Can PRP fix arthritis or regrow cartilage?

No. Articular cartilage has no real ability to repair itself, so PRP does not regrow it. PRP works by restarting a stalled repair. That is why degenerative tendons usually respond better than arthritic joints. The real goal is better function about three months out, such as climbing stairs without planning the route. If you expect new cartilage, we talk that through before treatment, not after.

How long should I try other treatments before PRP?

Most tendon pain and most plantar heel pain get better with loading exercises, time and less stress on the area. The window for PRP opens when symptoms have lasted past three to six months. You have made a real rehab attempt. And imaging shows degeneration (breakdown) rather than a rupture. Injecting earlier can mean paying for something you did not need.

Can I get PRP if I smoke or use nicotine?

Nicotine is not an automatic no, but it changes the odds. It narrows blood vessels in tissue that already has poor blood flow, and repair depends on that supply. Active nicotine use is one of our reasons to wait rather than go ahead, because stopping first materially improves your chances. We lay this out before you decide. That way you choose the order with the facts in hand.

Does PRP work for a completely torn tendon?

Usually not. A complete rupture is a mechanical problem. PRP works by restarting repair in tissue that can still heal. Large tears where the tendon has pulled back fall in the too-late group, because the problem has become structural and biology does not fix structure. If your assessment points toward a surgical opinion instead of an injection, you will be told so.

Can PRP work for someone over 50?

Age by itself does not decide it; the stage of the tissue and the terrain it repairs in do. In knee arthritis the grade on the X-ray predicts the response better than age does, so a 62-year-old with early joint-space loss and normal blood sugar is a better bet than a 45-year-old with a bone-on-bone knee and a rising A1C. What age does change is the terrain: insulin resistance and sarcopenic wasting both climb after fifty, and both are measured here rather than assumed. How stage changes the answer in the knee. Why two people the same age get different results.

Related reading

• Injury and work comp
• Paying for treatment
• Why a pain clinic asks to see your bloodwork
• Why the trials disagree
• How PRP works
• Risks and side effects
• Recovery timeline
• What we treat

The clinic is on Natural Bridge Road next to DePaul Hospital, just off the I-270 and I-70 junction and west of the airport. Free surface parking outside the door, ground-floor entrance, full-size elevator.

What your odds actually depend on, in order of size.