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

I-70 EAST ACROSS THE BLANCHETTE BRIDGE

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

The river is the psychological barrier, not the practical one

People in St. Charles County tend to think of medical care as something that happens in St. Charles County, and to 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, and for a good deal 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 unglamorous 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 and its working life is mixed in a way the older north county suburbs are not: construction and the trades, healthcare, office and technology work, and a large population of people who commute a long way each day.

Two of those produce a lot of what we see. The trades — carpentry, electrical, HVAC, plumbing — load shoulders overhead, elbows in grip-and-rotate, and knees against the floor, and they are jobs where the work does not pause because a tendon is sore. Long commuting matters more than people expect: sustained sitting shortens hip flexors, deconditions gluteal muscles, and it removes the incidental movement that keeps metabolic health from drifting. A weak abductor complex is one of the most reliable setups for lateral 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

The one that gets misdiagnosed most

Lateral hip pain is worth singling out because it is so often called bursitis and treated with a steroid injection into a bursa. The dominant pathology is tendinopathy of the gluteal tendons at their insertion, and injecting steroid around already-compromised 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. Which means the instinctive treatments — stretching the outside of the hip, foam rolling it, sleeping on the other side without a pillow between the knees — all make it worse. Explaining that is frequently 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 consequence: adolescent and young-adult knee pain that has been managed by resting through the off-season and flaring every spring.

Two cautions. In a skeletally immature athlete the problem is often the apophysis rather than the tendon, which is a different condition managed differently and not with an injection. And in a mature athlete, patellar tendinopathy responds to heavy slow resistance loading better than to anything in a syringe — the loading program is the treatment, and PRP is an adjunct where it has genuinely failed.

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

What the assessment includes

The joint you came about, the joints above and below it, ultrasound where it will change the answer, and a metabolic panel — because repair is an anabolic process running on whatever substrate is available, and a commuting, desk-bound, sleep-short life degrades that substrate quietly 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, which is a legitimate outcome of an assessment rather than 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, what you have already tried and for how long.
• Examination of the chain. Lateral hip pain frequently traces to gluteal weakness from years of sitting; elbow pain frequently traces to a shoulder that stopped rotating.
• Ultrasound in the room. It distinguishes a degenerate tendon from a partial tear from a tendon that is intact while something else generates the pain.
• Your imaging reviewed against the examination rather than in place of it. Scans find things in pain-free people constantly.
• A metabolic panel, ordered if you do not have recent labs.

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

Why we ask about blood sugar for a tendon problem

It reads as a non-sequitur and it is the most important question in the appointment.

A tendon repairs by laying down collagen, which is an anabolic process running on whatever the body can supply. In insulin resistance, microvascular delivery to an already poorly perfused enthesis is worse, and advanced glycation end-products cross-link collagen abnormally so the tissue that forms is stiffer and fails at lower strain. Meanwhile chronic adipose-derived inflammatory signaling holds the tissue in a degradative rather than building state.

The practical consequence: the same injection, in the same tendon, in two people with different metabolic pictures, produces different results. That is not a reason to refuse treatment. It is a reason to sequence it, and to tell you the odds honestly rather than quote an average from a trial that excluded 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 alternatives. Fifteen minutes, free-flow. Directions and contact.

My hip hurts on the outside. Is that arthritis?

Usually not — lateral 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, and we do not bill insurance. Why.

Related reading

• Areas we serve
• Am I a candidate?
• What to expect
• About Dr. Padda