Chronic tendinitis that won’t heal, in the Achilles, plantar fascia or patellar tendon, is usually tendinosis. That is a tendon that has broken down 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 we stop 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 messy collagen, fragile new blood vessels and cells that have stopped rebuilding. They have few inflammatory cells. Two decades later, most patients are still treated for the wrong disease.
Tendinitis means an inflamed tendon. It is real for a few days to weeks after a sudden strain. Tendinosis means a breaking-down tendon. The repair 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:
An ultrasound in the exam room shows the thickening, inner tears and abnormal vessels that mark tendinosis.
Cortisone fights inflammation, and it is very good at that job. But in a breaking-down tendon, it shuts down the cells that make collagen. Those are the same cells you need to rebuild. A 2010 Lancet review of 41 randomized trials showed the pattern. Steroid shots beat other treatments in the first month. Then the edge reversed at six months and one year. The pain left early and came back with a weaker tendon. Steroid near weight-bearing tendons like the Achilles also raises the risk of 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. They are concentrated from your own blood with an FDA-cleared device and placed into the damaged section under ultrasound. There they release growth signals that restart the stalled repair. The evidence differs by tendon, and you deserve to see it straight:
More on technique is on our tendon injection and PRP injections pages. For badly worn tendons, bone marrow concentrate brings the general contractor that organizes the repair crew. Dense scar can call for tendon debridement.
The procedure is done under local numbing. 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 depends on need. Some people feel better in three weeks. Others need a second or third treatment, based on how the tissue responds. You can’t make a carrot grow faster than it grows.
Lifestyle and behavior 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 torn-through tendon goes to surgery. Orthobiologics are the bridge between failed non-surgical 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 weight-bearing tendon. 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 rebuilds slowly. Many patients notice change within three to six weeks of starting treatment. 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 figure from our own patients, 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. We will look at the tendon on ultrasound and lay out a plan.
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