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

CANDIDACY

The useful version of this 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 and only the second one is worth your money.

The four things that decide it

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

One — is the tissue the kind that responds?

PRP works by restarting a stalled repair. That requires there to be a repair to restart. Degenerative tendon — disorganized collagen, failed healing, neovascular ingrowth — is the archetype, which is why tendinopathy generally outperforms arthritis.

Structures where the argument is weaker: articular cartilage, which has no meaningful self-repair capacity at all; a completely ruptured tendon, which is a mechanical problem; and pain arising from nerve rather than tissue, where there is nothing to heal in the place that hurts.

Two — what stage are you at?

Stage matters more than almost anything else and it cuts in two directions.

• Too early. Most tendinopathy and most plantar heel pain resolves with loading, time and load modification. Injecting before a genuine conservative trial means paying for something you may not have needed.
• The window. Symptoms past three to six months, a proper rehabilitation attempt behind you, imaging consistent with degeneration rather than rupture.
• Too late. Large retracted tears, or an expectation of structural repair in 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?

This is the part most clinics skip and the part that changes outcomes most quietly. An injection recruits a healing process, and that process runs on the raw materials and conditions available to it.

• Glycemic control. Glycated collagen is stiffer and fails earlier. Poorly controlled diabetes is the strongest modifiable predictor of a disappointing result, and it is a reason to sequence treatment rather than refuse it.
• Insulin resistance and visceral adiposity. These maintain a systemic inflammatory state that keeps tissue in a degradative rather than a building mode.
• Smoking and nicotine. Vasoconstriction in tissue whose problem is already marginal perfusion.
• Sleep. Most repair signaling happens overnight, and fragmented sleep measurably raises inflammatory tone.
• Thyroid, vitamin D and inflammatory disease. Each alters tendon healing and each is worth knowing about before rather than after.

None of these is a moral matter and none of them is a refusal. They change the odds, they change the sequence, and you are entitled to know about them before you decide.

Four — what are you expecting?

Someone expecting cartilage to regrow, or expecting relief next week, will be disappointed by a treatment that is working. Someone expecting a better chance of climbing stairs without planning the route, three months from now, is asking the right question of it.

We have that conversation before treatment than after.

Absolute reasons we will not treat

• Active infection at or near the target site
• Active malignancy, depending on type and treatment status
• Significant thrombocytopenia or a platelet function disorder — the treatment is made of your platelets
• Certain anticoagulation situations, which need individual discussion rather than a rule
• Pregnancy, on the general principle of not doing elective procedures

Reasons to wait rather than proceed

• Uncontrolled diabetes — treat the terrain, then the tendon
• A conservative trial that has not genuinely happened
• An unclear diagnosis, where imaging and examination disagree
• An untreated cervical or lumbar contributor driving what looks like limb pain
• Active nicotine use, where stopping first materially improves the odds

What the assessment actually involves

A history that covers what you do all day, not only where it hurts. An examination that includes the joint above and below, because limb pain is frequently referred. Review of your imaging against that examination rather than in place of it. Ultrasound in the room where it will change the answer. And a metabolic panel, because the questions in section three cannot be answered by looking at you.

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

Questions worth asking any clinic, including this one

• What specifically do you think is generating my pain, and how do you know?
• What is the realistic 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 is treating the scan. Imaging findings are common in pain-free people — disc bulges, rotator cuff tears, meniscal degeneration, heel spurs all appear at high rates in populations with no symptoms whatsoever. A report is a description of anatomy, not an explanation of pain, and the gap between the two is where a great deal of unnecessary treatment happens. If the examination does not agree with the scan, the examination usually wins.

The second is treating the loudest site. Someone with a painful shoulder, an aching knee, poor sleep and a rising A1C does not have four unrelated problems that happen to coincide. Chasing the loudest one with a needle produces a series of partial successes and a patient who slowly concludes that nothing works. It is more useful, and less expensive, 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 the shoulder failed, in the same plan, which is what the metabolic assessment is for.

Where this sits against pain medication

A specific candidacy note for anyone currently on opioids: being on them does not disqualify you here, and you will not be asked to taper as a condition of treatment. That approach makes people conceal what they are taking, which is worse for everyone. What we will do is aim at restoring function, because that is what eventually changes the dose question, and be honest if we think a regenerative option is unlikely to touch the thing driving your pain.

What people ask before booking

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

Sometimes, but multiple simultaneous joint involvement often points at a systemic 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 a sequence, 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 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, which is a legitimate outcome of an assessment. Contact us.

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.