--- title: "Tendon Injuries" --- ## When a Tendon Won't Heal Tendon problems have a particular kind of frustration. The pain is usually localized to a specific spot. Movement that involves the tendon makes it worse. Rest helps temporarily. Physical therapy helps somewhat. Anti-inflammatories take the edge off without fixing it. Cortisone might give short-term relief, but the pain comes back, sometimes worse than before. This pattern is common because tendon problems are not actually inflammatory in the way patients are often told. Most chronic tendon issues are degenerative: the tendon tissue itself has developed structural changes that will not resolve through anti-inflammatory treatment alone. What we offer is the regenerative approach to tendon care. Tendon injuries are one of the strongest evidence-based applications of regenerative medicine, and PRP therapy in particular has multiple high-quality clinical studies demonstrating meaningful benefit for chronic tendon problems. ## What Tendon Injuries Actually Are Tendons are the strong fibrous tissues that connect muscle to bone. Tendon problems develop in several patterns. Tendinopathy is the most common chronic condition; despite the older name "tendinitis" suggesting inflammation, most chronic tendon problems are degenerative, with the collagen fibers developing disorganization and structural changes. Tendinitis specifically refers to acute inflammation, which is less common. Partial tears involve some tearing without complete rupture, and complete ruptures often require surgical repair. This distinction matters because treatment differs. Tendinopathy responds well to regenerative treatments and progressive loading rehabilitation. Acute tendinitis may respond to anti-inflammatory measures. Complete ruptures often need surgical evaluation. Common patterns we treat include tennis elbow, golfer's elbow, rotator cuff tendinopathy, patellar tendinopathy (jumper's knee), Achilles tendinopathy, gluteal tendinopathy, hip flexor and hamstring tendinopathy, and de Quervain's tenosynovitis. ## Why Cortisone Is Often the Wrong Answer for Tendons Cortisone is widely used for tendon problems but has specific concerns when used repeatedly. Multiple studies have shown that while cortisone provides short-term pain relief, repeated cortisone in a tendon may actually weaken the tissue and increase the risk of tendon tear, and long-term outcomes from repeated cortisone in tendons are often worse than from other approaches. For most chronic tendinopathies, the better approach involves activity modification and progressive loading rehabilitation, treatments that support tendon tissue health rather than only masking pain, and time for tissue-level healing. This is part of why PRP and other regenerative options have become preferred over repeated cortisone for many tendon problems; they support the tissue rather than working against it. ## How PHI Treats Tendon Injuries The first step is comprehensive evaluation: a detailed history of how long the problem has been present and what has been tried, an examination of the specific tendon, review of imaging (often ultrasound or MRI), and an assessment of whether PRP or other regenerative options fit. PRP therapy is the most evidence-supported regenerative treatment for tendinopathy, with multiple high-quality randomized trials demonstrating improvement in pain and function, particularly for tennis elbow, patellar tendinopathy, and rotator cuff problems; most patients receive a series of injections with progressive improvement over 3 to 6 months. A2M therapy may be appropriate where there is joint involvement alongside the tendinopathy. Stem cell therapy is considered for selected severe or refractory cases that have not responded to PRP, and exosome therapy is used within comprehensive protocols. PHI uses ultrasound-guided technique for tendon injections, performed at our Beverly Hills practice, and coordinates with physical therapy, since eccentric loading and progressive rehabilitation work synergistically with regenerative treatment. ## When to See Someone Consider professional evaluation when your tendon problem has lasted more than four to six weeks without improvement, when it interferes with sports, work, or daily activities, when standard care has not produced lasting relief, when you have had multiple cortisone injections in the same tendon, or when you want regenerative options that support tissue healing rather than just symptom management. Seek prompt evaluation for sudden severe pain with a popping sensation (suggesting possible rupture), significant weakness or inability to perform a movement, visible deformity, or severe swelling or signs of infection. Suspected tendon rupture warrants urgent evaluation because timing affects surgical decision-making. ## Why PHI for Tendon Injuries ## Frequently Asked Questions **Q: How effective is PRP for tendon injuries?** For appropriate candidates with chronic tendinopathy, PRP has accumulating evidence demonstrating meaningful improvement in pain and function. Multiple high-quality randomized trials and meta-analyses support its use, particularly for tennis elbow, patellar tendinopathy, and rotator cuff tendinopathy. Response varies, but PRP is one of the most evidence-supported regenerative applications in musculoskeletal medicine. **Q: How many PRP treatments will I need?** Most patients receive a series rather than a single injection. Typical protocols involve two to three PRP injections spaced several weeks apart, with continued improvement evaluated over 3 to 6 months. Some patients benefit from additional treatments depending on response and specific tendon involvement. **Q: Why shouldn't I just get a cortisone shot?** For acute tendinitis, cortisone may be appropriate. For chronic tendinopathy, repeated cortisone has concerning effects on tendon tissue; studies show that while it provides short-term relief, repeated cortisone may weaken the tissue and increase rupture risk, and long-term outcomes are often worse than with regenerative approaches. **Q: How long until I can return to activity?** This varies by tendon and severity. PRP typically requires several weeks of restricted activity after each injection to allow optimal tissue response. Full return to high-level activity usually takes 3 to 6 months from the start of treatment, with continued lower-impact activity often possible during the treatment period. **Q: Should I keep doing physical therapy?** Yes. Tendon care works best when regenerative treatment is combined with appropriate progressive loading rehabilitation. Eccentric loading exercises in particular have strong evidence for tendinopathy, and PT plus PRP together typically produce better outcomes than either alone. **Q: What if PRP doesn't work?** Most patients with chronic tendinopathy respond at least partially to PRP. For patients with insufficient response, options include additional PRP treatments, transitioning to other regenerative approaches like stem cell therapy, or surgical evaluation for specific situations. **Q: Is PRP banned in my sport?** PRP is permitted by WADA and most major sports governing bodies for musculoskeletal applications. Some specific organizations have additional considerations for elite athletes; we discuss specifics during consultation if you compete at that level. **Q: What's the difference between tendinitis and tendinopathy?** Tendinitis specifically refers to acute inflammation of a tendon. Tendinopathy refers to chronic structural changes in tendon tissue, which is what most patients with chronic tendon problems actually have, despite tendinitis being the older common term. The distinction matters because treatment approaches differ. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Tendon Injuries PHI offers evidence-based regenerative treatments for tendon injuries. Your physician will recommend the right option, or combination, based on your specific tendon, severity, and treatment history. - PRP Therapy, the most evidence-supported regenerative treatment for tendinopathy - Stem Cell Therapy, for selected severe or refractory cases - A2M Therapy, where there is joint involvement alongside the tendinopathy - Exosome Therapy > Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: a systematic review and meta-analysis of randomised injection-controlled trials. Peer-reviewed via PMC, 2017. — [Miller LE, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC5687544/) > The effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis of randomized controlled clinical trials. American Journal of Sports Medicine, peer-reviewed via PubMed, 2017. — [Fitzpatrick J, et al.](https://pubmed.ncbi.nlm.nih.gov/27268111/) > The effect of low-level red and near-infrared photobiomodulation on pain and function in tendinopathy: a systematic review and meta-analysis of randomized control trials. Peer-reviewed via PMC, 2021. — [Tripodi N, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8364035/) > Clinical practice guideline: management of rotator cuff injuries. American Academy of Orthopaedic Surgeons. — [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/upper-extremity-programs/rotator-cuff-injuries/) ## Schedule Your Tendon Injury Consultation A 60-minute consultation will identify your specific tendon condition, walk through the regenerative options that match it, and give you a clear plan with realistic expectations. 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For appropriate candidates with chronic tendinopathy, PRP has accumulating evidence demonstrating meaningful improvement in pain and function. Multiple high-quality randomized trials and meta-analyses support its use, particularly for tennis elbow, patellar tendinopathy, and rotator cuff tendinopathy. Response varies, but PRP is one of the most evidence-supported regenerative applications in musculoskeletal medicine.

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Most patients receive a series rather than a single injection. Typical protocols involve two to three PRP injections spaced several weeks apart, with continued improvement evaluated over 3 to 6 months. Some patients benefit from additional treatments depending on response and specific tendon involvement.

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For acute tendinitis, cortisone may be appropriate. For chronic tendinopathy, repeated cortisone has concerning effects on tendon tissue; studies show that while it provides short-term relief, repeated cortisone may weaken the tissue and increase rupture risk, and long-term outcomes are often worse than with regenerative approaches.

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This varies by tendon and severity. PRP typically requires several weeks of restricted activity after each injection to allow optimal tissue response. Full return to high-level activity usually takes 3 to 6 months from the start of treatment, with continued lower-impact activity often possible during the treatment period.

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Yes. Tendon care works best when regenerative treatment is combined with appropriate progressive loading rehabilitation. Eccentric loading exercises in particular have strong evidence for tendinopathy, and PT plus PRP together typically produce better outcomes than either alone.

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Most patients with chronic tendinopathy respond at least partially to PRP. For patients with insufficient response, options include additional PRP treatments, transitioning to other regenerative approaches like stem cell therapy, or surgical evaluation for specific situations.

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PRP is permitted by WADA and most major sports governing bodies for musculoskeletal applications. Some specific organizations have additional considerations for elite athletes; we discuss specifics during consultation if you compete at that level.

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Tendinitis specifically refers to acute inflammation of a tendon. Tendinopathy refers to chronic structural changes in tendon tissue, which is what most patients with chronic tendon problems actually have, despite tendinitis being the older common term. The distinction matters because treatment approaches differ.

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Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.

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