Every tissue on this list has a different honest answer

WHAT WE TREAT

PRP is not a cure-all. It works far better in some tissues, and in some patients, than in others. So this page also lists the cases where it is a poor bet.

Knee osteoarthritis

This is where the evidence is strongest. PRP does more for an earlier-stage knee that still has joint space left than for a bone-on-bone knee. By then the damage is structural, and no biological signal can undo it. If your knee has already lost most of its cartilage, PRP will not rebuild it, and we will tell you so. We still use it at that stage, for a narrower purpose: to buy time and cut how much medication the day takes.

Tendinopathy

Tennis elbow, golfer’s elbow, the kneecap tendon, the gluteal tendons, the rotator cuff, the Achilles. A long-standing tendon problem is not really an inflammation. It is a repair that stalled, leaving the collagen fibers in disarray. That is exactly what PRP is meant for, and tendons often respond better than joints do.

Plantar fasciitis

We usually consider this after stretching, night splints, orthotics and time have had a fair trial. The plantar fascia is a dense band with a poor blood supply. That is part of why it heals so slowly, and part of why a delivered growth-factor signal can matter.

Hip and shoulder osteoarthritis

Selected cases only. These joints sit deeper, so we use image guidance to place the needle accurately. The evidence here is thinner than for the knee.

Discogenic back and neck pain

This is pain in the back itself, not pain shooting down a leg. The disc is making the pain rather than pressing on a nerve. It is the most tightly gated treatment on this site. We inject nothing until a provocation test or a discogram shows the disc is the source, because a scan alone will not tell you. If a fragment is pressing on a nerve root, no injection fixes that — see a herniated or bulging disc.

Facet joint pain

Neck or low back pain that stays near the midline and shows a facet pattern on examination. We confirm it with a numbing test called a medial branch block. The facet is the one spinal target we can name with confidence, so we treat it more readily than the disc. It is often the alternative to a cycle of radiofrequency ablation, redone every eight to eighteen months.

Sacroiliac joint pain

People mistake this for the hip or the low back all the time. That is why telling those three apart has its own page. We treat it only after a block confirms the level, under the same rule that governs everything else we do in the spine.

Pain that persists after spine surgery

An operation can go exactly as planned and still leave you in pain. The reasons are mostly foreseeable. The first job is to stop treating “failed back surgery” as a diagnosis and find out what is making the pain now. It is often not the thing that was operated on. The neck version is covered separately.

Ligament and muscle injury

Partial ligament tears and muscle injuries that have not resolved on the expected schedule.

When PRP is a poor bet

• End-stage joint destruction, if what you are expecting is structural repair rather than time and a lower medication burden
• An active infection anywhere near the target
• Certain blood and platelet disorders
• Active malignancy, depending on type and treatment status
• Uncontrolled diabetes or severe untreated metabolic disease. This is not a permanent no. It is a reason to treat the body first and the tendon second.

That last one is the one people argue with. The reasoning is in how PRP works: an injection calls in a repair process, and that process runs on whatever your body has to work with.

Where to read next

Tendon and joint

• PRP for knee osteoarthritis
• PRP for hip osteoarthritis
• PRP for rotator cuff tendinopathy
• PRP for tennis elbow
• PRP for golfer’s elbow
• PRP for Achilles tendinopathy
• PRP for plantar fasciitis
• PRP for patellar tendinopathy
• PRP for gluteal tendinopathy

Spine, disc and nerve

We treat the spine differently here. We inject no level until a numbing test confirms it is the right one.

• PRP for the disc
• PRP for the facet joints
• Spine and the sacroiliac joint
• Platelet lysate — what we use near a nerve

After surgery

An operation can go exactly as planned and still leave pain behind. The reasons are mostly foreseeable, and rarely anyone’s error.

• Still in pain after back surgery
• Still in pain after neck surgery

When nobody can tell you which structure it is

These two questions account for a great deal of treatment aimed at the wrong target.

• Is it my shoulder or my neck?
• Hip, SI joint or lumbar spine?

The treatments themselves

• How platelet-rich plasma works
• Bone marrow aspirate concentrate
• Prolotherapy
• Platelet lysate
• Am I a candidate?
• Why a pain clinic asks to see your bloodwork
• Why the trials disagree

Why tendons generally do better than joints

A pattern runs through every page linked above and it is worth stating once, plainly.

A long-standing tendon problem is a failed repair. The tissue tried to heal, stalled partway, and settled into a worn-out state. The collagen fibers lie in disarray, and new blood vessels and nerves have grown in where they do not belong. There is a repair to restart, and that is exactly what a growth-factor preparation is for.

Arthritis is different. Joint cartilage has no blood supply and almost no ability to repair itself, so there is no stalled healing to restart. In a joint, PRP appears to change the environment instead. It quiets the signals that break tissue down, and it shifts how the joint lining behaves. That can cut pain and improve function without changing the X-ray at all.

Both are worth doing in the right patient. But they are not the same deal, and you should not expect the same thing from each.

When several things hurt at once

Say your shoulder aches, your knee aches, your heel hurts and you sleep badly. That is rarely four unrelated injuries that happened to arrive together. Several sore tendons at once is one of the clearest signs that something body-wide is driving it. Usually that is insulin resistance, or a steady inflammatory load. Sometimes it is an inflammatory arthritis nobody has named yet.

Inject the loudest one and you get a partial win, and a patient who slowly decides nothing works. The better question is why several tissues are failing at once. Then treat that, alongside whichever one hurts most.

What we do not treat

• Cosmetic and hair-restoration uses of PRP. Different field, and not what this practice does.
• Injection inside a disc when nobody has confirmed the disc is the source. We do treat the disc, but only for midline pain proven with a block, never guessed from a scan. Infection inside the disc is the risk that makes us select so carefully. See PRP for the disc.
• Acute fractures, infections, and anything requiring urgent surgical care.
• Pain that comes from a nerve rather than from damaged tissue. There is nothing to heal at the spot that hurts.

How we decide what to offer

Four questions, in order, and a patient can fail at any of them.

• Is the tissue the kind that responds? A stalled repair can be restarted. Cartilage loss, a complete rupture, or nerve-generated pain cannot.
• What stage is it at? Too early, and most people would have got better anyway. Too late, and the problem has become structural.
• What condition is the rest of you in? Blood sugar control, sleep, nicotine and inflammation all decide what the tissue has to build with.
• What are you expecting? The wrong expectation turns a working treatment into a disappointment.

Each one is expanded on the candidacy page. That is the more useful read if you are deciding whether to book.

The other treatments we use

PRP is not the only option here, and a practice offering exactly one thing tends to find that everyone needs it.

• Bone marrow aspirate concentrate
• Prolotherapy
• PRP compared with cortisone
• PRP compared with hyaluronic acid injections
• PRP compared with surgery
• PRP compared with stem cell treatments

What every one of these has in common

Whatever we inject, your tissue does the building. That is not a slogan. It is why the same treatment gives different results in different people, and why we ask about your sleep and your blood sugar before we treat a tendon.

It is also why the exercise program is not aftercare. Collagen lines itself up along the direction of load. Tissue that is never loaded lays down fiber in disarray, and rebuilds the problem you started with. The procedure buys you a window. What you do fills it. Here the behavioral and metabolic work is roughly 40–50% of the plan, not a sheet handed over at discharge.

Conditions we are asked about and decline

A short list, because being told no with a reason is more useful than being told yes without one.

Low back pain, generally. Often nobody can say which structure is making the pain. Injecting inside the disc has a weak evidence base and real risks. And most long-standing back pain has a large nervous-system and behavioral component that no injection touches. If a specific structure has been identified — a sacroiliac joint, a facet, a ligament attachment — there is more to discuss.

Arthritis of the hands and thumb base. Small joints and thin evidence. These respond well to splinting and to changing how you load the hand, and that should be tried first.

Meniscal and labral tears on their own. These are usually signs of wear rather than targets you can repair. In randomized trials, keyhole surgery for a worn meniscus did no better than fake surgery.

Anything in the first six weeks. Most new tendon pain settles on its own. Treating it early means charging someone for a recovery they were going to have anyway.

If your problem is not on this list

The pages above cover what we see most often, not everything we will look at. Say you have a stubborn tendon or joint problem that has outlasted a real conservative trial. The assessment is the same whichever structure it is. What is failing? What stage is it at? What shape is the rest of you in? And is a biological treatment a fair bet, or a waste of your money?

Sometimes the answer is that it is a waste of your money, and you will be told that.

What people ask before choosing a page

Which conditions respond best?

Worn, long-standing tendon problems generally do better than arthritis. A stalled repair can be restarted. Cartilage cannot repair itself at all. Tennis elbow is the clearest example.

My pain is on the outside of my hip. Which page is that?

Almost certainly gluteal tendinopathy rather than the hip joint — and the treatments differ completely. Gluteal tendinopathy.

My scan shows a tear. Does that change things?

It depends on the size and the site. Tears are common in people with no pain at all, so a report describes your anatomy rather than explains your pain. Why that matters most in the shoulder.

Several joints hurt at once. Is that treatable?

Sometimes. But several joints at once usually points to a body-wide driver, and that is worth treating alongside whichever joint is worst. How we assess that.

Do you treat back pain?

Yes, but only when a numbing test has identified the structure making the pain. We do not guess it from a scan. That rule is the whole of our spine practice. Why we block before we inject.

How do I know if it is too early to treat?

Most new tendon pain settles on its own. Under six months, with no real exercise program tried, is usually too early. What a proper program looks like.

Why symptom-based silos keep failing this

Four painful spots get four appointments with four clinicians. Each one treats their own region competently. Nobody owns the question of why four tissues failed in the same body in the same decade. There is no billing code for that question, and no clinic built around it.

So the shoulder gets injected, the knee gets a gel shot, the heel gets an orthotic, and the person decides medicine has done what it can. Meanwhile the real driver goes unnamed. It is a low-grade, body-wide inflammation, fed by insulin resistance, refined carbohydrates and broken sleep. And it keeps breaking down collagen in all four places at once.

Muscle loss makes it worse. Moving less costs you muscle. Less muscle means more force through the joint and worse blood sugar control. Worse blood sugar feeds the inflammation, and the inflammation takes more tissue. Nobody chooses that spiral. It is what happens when every part is managed correctly and the whole is managed by nobody.

What we are actually treating

The tissue, and the condition of the body it is failing in. A procedure buys you a window, and that is a real and useful thing to buy. What fills the window decides whether you are back in twelve months.

So: the injection where it is warranted. The exercise program that tells new collagen how to line up. And honest attention to the sleep, diet and blood sugar that decide what the repair has to build with. Any page here that lists only procedures is incomplete, and several of these pages will tell you not to have an injection at all.

If your problem started with an injury at work or in a collision, the payment route and the documentation both change — see injury and work comp.