What can I try before I consider surgery?

What usually helps first?

First, change the activity that keeps stirring the soreness. You might shorten a walk or play fewer games. Then rebuild strength at a pace you can handle. This is often the base of tendon care.

A brace, tape, or shoe insert can reduce strain for some problems. These aids work like a handrail. They can support you, but they don't rebuild strength. Your clinician can tell you whether one fits the sore area.

Some medicine can ease soreness for a short time. Ask how long relief could last and which risks apply. You'll still need safe movement and strength work.

Where do PRP and blood flow restriction training fit?

For platelet-rich plasma (PRP), the clinic takes some of your blood. A machine spins it to gather a part with more platelets. That part is then given as a shot. Clinics don't all prepare it the same way.

Blood flow restriction training uses a wide cuff around an arm or leg. The cuff applies pressure while you lift a light weight. It can help build strength when heavy lifting is too hard. Think of the cuff as a firm blood-pressure cuff used during exercise.

These choices don't replace an exam. Ask what change the clinician expects in your soreness or daily movement. Also ask about cost, risks, and follow-up.

What happens when I discuss non-surgical care?

The visit begins with your soreness and daily limits. The clinician asks how it began and what makes it worse. You then move the joint while the clinician checks strength, swelling, and sore areas.

An old X-ray can help show a past break or earlier joint changes. It matters only if the clinician needs to compare those findings with today's exam. Otherwise, a new exam may tell more than the old picture.

Ask why an option fits what the clinician found. Ask what happens if it doesn't help. You can also discuss cost, risks, and time away from activity.

Before the visit, note the daily task that hurts most. QC Kinetix provides regenerative treatments, which are non-surgical options given by the clinicians who examine you there.

Sources

1. A network meta-analysis of 37 randomised trials in patellar tendinopathy found that focused extracorporeal shockwave therapy was NOT superior to sham shockwave for short-term pain (MD +0.1, 95% CI -0.8 to 1) or function (MD -1.8, -8 to 4.4) when both groups did eccentric exercise, and that isometric exercise was about as effective as isotonic exercise for immediate post-exercise pain relief (MD -1.03, -2.6 to 0.5). Most of the 33 interventions assessed were represented by a single study and the strength of evidence was low to very low; the authors conclude eccentric loading with or without adjuncts should remain first-line.

   Challoumas D, et al. — Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies.. BMJ Open Sport Exerc Med, 2021. DOI: 10.1136/bmjsem-2021-001110.

2. In a small single-blinded randomised cross-over study of six volleyball players with patellar tendinopathy, a single bout of ISOMETRIC contractions cut single-leg decline squat pain from 7.0 to 0.2 out of 10 and the relief was still present 45 minutes later, while isotonic contractions cut pain from 6.3 to 3.8 and the effect was not sustained. Maximal voluntary isometric contraction strength rose 18.7% after the isometric bout. The sample is six athletes - this is a mechanism signal, not a treatment trial.

   Rio E, et al. — Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy.. Br J Sports Med, 2015. DOI: 10.1136/bjsports-2014-094386.

3. A meta-analysis of 20 studies of low-load blood flow restriction training in clinical musculoskeletal rehabilitation - including ACL reconstruction, knee osteoarthritis and older adults at risk of sarcopenia - found a moderate effect on strength (Hedges' g 0.523, 95% CI 0.263-0.784), less than heavy-load training achieved (g 0.674, 0.296-1.052). The authors position it as a tool for people who cannot yet tolerate heavy load, not as a replacement for it.

   Hughes L, et al. — Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis.. Br J Sports Med, 2017. DOI: 10.1136/bjsports-2016-097071.

4. Thirty-nine men with patellar tendinopathy were randomised to peritendinous corticosteroid injection, eccentric decline squats or heavy slow resistance training for 12 weeks. All three improved at 12 weeks - but at the half-year follow-up the gains were MAINTAINED in the two exercise groups and had DETERIORATED in the corticosteroid group. Heavy slow resistance also produced elevated collagen network turnover and the highest treatment satisfaction at follow-up.

   Kongsgaard M, et al. — Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy.. Scand J Med Sci Sports, 2009. DOI: 10.1111/j.1600-0838.2009.00949.x.

5. One hundred and eighty shoulders with symptomatic, non-traumatic supraspinatus tears were randomised to physiotherapy alone, acromioplasty plus physiotherapy, or rotator cuff repair plus acromioplasty and physiotherapy. At two years there was no significant difference in Constant score (18.4, 20.5 and 22.6 points of improvement respectively, p=0.38), pain or satisfaction, while the surgical arms cost significantly more. The repaired tears were smaller on imaging, and the authors flag the need for longer follow-up on tear progression.

   Kukkonen J, et al. — Treatment of Nontraumatic Rotator Cuff Tears: A Randomized Controlled Trial with Two Years of Clinical and Imaging Follow-up.. J Bone Joint Surg Am, 2015. DOI: 10.2106/JBJS.N.01051.

6. A systematic review of 105 clinical orthopaedic PRP studies found that only 11 (10%) described the preparation protocol well enough for another investigator to repeat it, and only 17 (16%) gave any quantitative measure of what was actually in the final PRP product. Without that, trials of 'PRP' cannot be meaningfully compared with one another - which is the single largest reason the tendon and joint literature disagrees with itself.

   Chahla J, et al. — A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature.. J Bone Joint Surg Am, 2017. DOI: 10.2106/JBJS.16.01374.

7. FDA states verbatim that stem cells, stromal vascular fraction, umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products have not been approved 'for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' Tendonitis and tennis elbow are named explicitly. No exosome product holds FDA approval at all, and the only stem cell products with FDA approval in the United States are blood-forming cells derived from umbilical cord blood, cleared only for disorders of blood production. FDA also states it has received reports of blindness, tumour formation and infections following treatment with unapproved products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.

8. Medicare's national coverage policy covers autologous platelet-rich plasma ONLY for patients with chronic non-healing diabetic, pressure and/or venous wounds, and only inside an approved coverage-with-evidence-development study. There is no Medicare national coverage for PRP in tendinopathy, muscle injury or osteoarthritis, which is why these injections are billed to the patient.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS.gov, 2024.