Chronic tendinitis that won’t heal, in the Achilles, plantar fascia or patellar tendon, is usually tendinosis: a tendon that has degenerated after months of failed repair. In St. Louis we treat it by restarting that repair with platelet-rich plasma (PRP), graded loading and metabolic correction, and by stopping the cortisone that weakens tendon.
You were told it was tendinitis. You took the anti-inflammatories, iced it, rested it, maybe got a cortisone shot. Months later the heel still stabs on the first step out of bed, or the knee still aches going down stairs. Nothing failed by accident. The treatment was aimed at inflammation, and a tendon that has hurt for more than three months is rarely inflamed.
In 2002, a group of tendon researchers wrote in the BMJ that it was time to abandon the “tendinitis” myth. Under the microscope, chronically painful tendons show disorganized collagen, fragile new blood vessels and cells that have stopped rebuilding, with few inflammatory cells. Two decades later, most patients are still being treated for the wrong disease.
Tendinitis means an inflamed tendon. It is real for a few days to weeks after an acute strain. Tendinosis means a degenerating tendon: the repair process started, stalled and left behind weak, messy tissue. Picture a road crew that tore up the pavement, poured half the new asphalt and walked off the job. The road is worse than before and nobody is coming back.
The tendons where this happens most:
Ultrasound in the exam room shows the thickening, internal tears and abnormal vessels that define tendinosis.
Cortisone is an anti-inflammatory, and it is very good at that job. In a degenerating tendon, it shuts down the cells that make collagen, the same cells you need to rebuild. The 2010 Lancet review of 41 randomized trials showed the pattern: steroid injections beat other treatments in the first month, and then the advantage reversed at six months and one year. The pain left early and came back with a weaker tendon. Steroid near load-bearing tendons like the Achilles also raises the stakes on rupture. Our page on cortisone side effects covers the rest.
Tendon has a poor blood supply to begin with. Three forces then decide whether repair finishes or stalls:
Platelets are the repair workers. Concentrated from your own blood in an FDA-cleared device and placed into the damaged section under ultrasound, they release growth signals that restart the stalled repair. The evidence differs by tendon, and you deserve to see it straight:
More on technique sits on our tendon injection and PRP injections pages. For heavily degenerated tendons, bone marrow concentrate brings the general contractor that organizes the repair crew, and dense scar can call for tendon debridement.
The procedure is done under local anesthetic. You are awake, there is no sedation, and most patients drive themselves home. Expect soreness for about 48 hours. Protect the area for the first few days and follow the rehab plan.
The number of injections follows clinical need. Some feel better in three weeks; others need a second or third treatment, decided by how the tissue responds. You can’t make a carrot grow faster than it grows.
Lifestyle and behavioral work is 40 to 50 percent of our protocol, because the injection only restarts repair. Loading finishes it.
Dr. Padda is a licensed physician and surgeon. A ruptured tendon goes to surgery. Orthobiologics are the bridge between failed conservative care and an operation.
More on this condition from Dr. Padda on YouTube:
After about three months, most tendon pain is tendinosis, a stalled repair. Rest and anti-inflammatories do not restart it. Graded load, metabolic correction and, when needed, PRP do.
We avoid it. Steroid weakens the collagen of a load-bearing tendon, and trials show steroid benefits reverse by six months.
Yes. Pooled trials show PRP matches cortisone early and beats it in the medium term for chronic plantar fasciitis.
Months. Collagen remodels slowly. Many patients notice change within three to six weeks of starting treatment, and strength keeps building after that.
No. We use local anesthetic, you stay awake, and most patients drive themselves home.
PRP is not billed to insurance. HSA and FSA funds are generally eligible.
A tendon that has hurt for six months is not going to fix itself with another month of rest. Over 90% of our accepted case-study patients see significant improvement. That is a practice-reported figure from our own population, not a trial outcome, and individual results vary. Request the orthobiologics guide above, or call our office at 4477 Woodson Rd in St. Louis at (314) 481-5000 and we will look at the tendon on ultrasound and lay out a plan.
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