Closer than most of St. Louis city, which almost nobody in St. Charles expects.

I-70 EAST ACROSS THE BLANCHETTE BRIDGE

St. Charles patients get PRP and orthobiologic injections from us fifteen minutes and about eight and a half miles away. The trip crosses the Missouri River, mostly on the highway. The county sends us gluteal tendinopathy, hip and knee osteoarthritis, rotator cuff tendinopathy, tennis elbow and patellar tendinopathy.

St. Charles sits across the Missouri River from us. That sounds further than it drives. It is fifteen minutes and about eight and a half miles, most of it on the highway.

How far is the PRP clinic from St. Charles?

People in St. Charles County tend to think medical care happens in St. Charles County. They treat crossing the river as a project. In driving terms it is not. The Natural Bridge corridor is a straight run from the I-370 and Missouri River bridge approaches. For a good part of the county, we are closer than the clinics people default to in Creve Coeur or Chesterfield.

Free surface parking, ground-floor entrance, no garage. That combination is plain, and it is what people with a painful hip actually ask about.

A different working population

St. Charles is the fastest-growing part of the region. Its working life is mixed in a way the older north county suburbs are not. There is construction and the trades, healthcare, office and tech work. And there is a large population of people who commute a long way each day.

Two of those produce a lot of what we see. The trades, like carpentry, electrical, HVAC and plumbing, load shoulders overhead, elbows in grip-and-twist, and knees against the floor. In these jobs, the work does not pause because a tendon is sore. Long commuting matters more than people expect. Long sitting shortens the hip flexors and weakens the gluteal muscles. It also removes the small everyday movement that keeps metabolic health from drifting. Weak abductors (outer hip muscles) are one of the most reliable setups for lateral (outer) hip pain there is.

The conditions that follow

• Gluteal tendinopathy — lateral hip pain that ruins side-lying sleep
• Hip osteoarthritis — groin pain and lost rotation, a different problem
• Knee osteoarthritis
• Rotator cuff tendinopathy
• Tennis elbow
• Patellar tendinopathy — the jumping and deceleration injury

Why is outer hip pain so often misdiagnosed?

Lateral (outer) hip pain is worth singling out because it is so often called bursitis. It gets treated with a steroid injection into a bursa (a small fluid sac). But the main problem is tendinopathy of the gluteal tendons where they attach. And injecting steroid around already-weakened tendons has been associated with progression to tearing.

The mechanism is compression. Anything that brings the knee toward the midline presses the iliotibial band into the tendon. That means the gut-reaction treatments all make it worse. Those are stretching the outside of the hip, foam rolling it, and sleeping on the other side without a pillow between the knees. Explaining that is often more useful than anything we inject, and it is free.

The full explanation, including what actually helps and in what order.

Youth sport, and the knee that will not settle

St. Charles County plays a lot of organized youth sport, and we see the result. Teens and young adults come in with knee pain. It has been managed by resting through the off-season, and it flares every spring.

Two cautions. In an athlete who is still growing, the problem is often the apophysis (the growth plate), not the tendon. That is a different condition. It is managed differently, and not with an injection. And in a grown athlete, patellar tendinopathy responds to heavy slow resistance loading better than to anything in a syringe. The loading program is the treatment. PRP is an add-on where it has truly failed.

Anyone who offers a teen an injection before a proper loading program has been run is selling. What actually works for patellar tendinopathy.

What the assessment includes

We look at the joint you came about, the joints above and below it, ultrasound where it will change the answer, and a metabolic panel. That is because repair is an anabolic (building) process that runs on whatever raw material is available. A life of commuting, desk work and short sleep quietly degrades that raw material for years before anything hurts.

The four questions that decide candidacy are on the candidacy page. A fair number of people leave without an injection. That is a legitimate result of an assessment, not a wasted trip.

The options, including the cheaper ones

• How platelet-rich plasma works
• Prolotherapy — real evidence in knee arthritis, substantially cheaper
• Bone marrow aspirate concentrate
• PRP compared with cortisone
• PRP compared with gel injections
• PRP compared with surgery

What a first visit actually looks like

Allow an hour. Most of it is not the injection.

• History that covers the day, not the diagnosis. What your hands and shoulders do, how far you drive, how you sleep, and what you have already tried and for how long.
• Examination of the chain. Lateral (outer) hip pain often traces back to gluteal weakness from years of sitting. Elbow pain often traces back to a shoulder that stopped rotating.
• Ultrasound in the room. It tells apart a degenerate tendon, a partial tear, and an intact tendon with something else causing the pain.
• Your imaging reviewed against the examination, not in place of it. Scans find things in pain-free people all the time.
• A metabolic panel, ordered if you do not have recent labs.

At the end you get an opinion. That includes the opinion that an injection is a poor bet for you, if that is what we think.

Why does blood sugar matter for a tendon problem?

It sounds off-topic, and it is the most important question in the appointment.

A tendon repairs by laying down collagen. That is an anabolic process that runs on whatever the body can supply. In insulin resistance, delivery through the tiny blood vessels is worse. And the enthesis (where tendon meets bone) already has poor blood flow. Advanced glycation end-products (sugar-damaged proteins) cross-link collagen abnormally. So the tissue that forms is stiffer and fails at lower strain. Meanwhile, ongoing inflammatory signals from fat tissue keep the tissue breaking down instead of building.

Here is the practical result. The same injection, in the same tendon, in two people with different metabolic pictures, gives different results. That is not a reason to refuse treatment. It is a reason to sequence it. And it is a reason to tell you the odds honestly instead of quoting an average from a trial that left out people like you.

Why those trials excluded them, and what it means for your decision.

What people from St. Charles ask

Is it worth crossing the river?

For much of the county, we are closer than the other options. Fifteen minutes with no traffic. Directions and contact.

My hip hurts on the outside. Is that arthritis?

Usually not. Lateral (outer) hip pain is generally tendon; groin pain is generally joint. Gluteal tendinopathy.

Should my teenager have PRP for jumper’s knee?

Almost certainly not before a proper loading program. And not at all if it is an apophysis. Patellar tendinopathy.

Do you take insurance for this?

This is a self-pay practice. We do not bill insurance. Why.

Is there anything better than PRP for knee arthritis?

Sometimes. Prolotherapy has real evidence in knee arthritis. Gel injections, cortisone and surgery are the other options worth weighing, each with its own page. Which one fits depends on your knee, your metabolic health and what you have already tried. At the end of your assessment you get an opinion. That includes the opinion that an injection is a poor bet for you, if that is what we think.

Can sitting all day cause hip pain?

It can set it up. Long commuting and desk work shorten the hip flexors and weaken the gluteal muscles. They also remove the everyday movement that keeps metabolic health from drifting. Weak abductors are one of the most reliable setups for lateral (outer) hip pain there is. St. Charles has a large population of long-distance commuters, and we see this pattern often.

Will I get an injection at my first visit?

Not necessarily. Allow an hour, and most of it is not the injection. We take a history of your working day. We examine the joints above and below. We use ultrasound in the room. We check your imaging against the exam. And we order a metabolic panel if you have no recent labs. A fair number of people leave without an injection, which is a legitimate outcome.

Related reading

• Areas we serve
• Am I a candidate?
• What to expect
• About Dr. Padda
• PRP in St. Peters, MO