Choose what to try before surgery

Try movement that doesn't raise the soreness

Complete rest can weaken the whole arm or leg. A smaller amount of comfortable movement may help you keep strength while soreness settles.

Rehab means planned exercises done at home or during visits with a therapist. The exercises shouldn't leave the joint much worse the next morning.

A brace, tape, or different shoes may make some tasks easier. Medicine may ease soreness, but it can't rebuild strength on its own.

Ask exactly what the blood-based care involves

At its Peoria office, QC Kinetix provides regenerative treatments; the term means non-surgical care using your blood, carried out by medical providers, or staff members trained to perform it. Results can differ, so ask what changes are realistic for your soreness.

The letters PRP refer to platelet-rich plasma, the platelet-heavy part kept after the team draws and spins some of your blood. The person giving the treatment then places that prepared blood part into the sore joint or tendon.

Ask for the full price and number of visits before agreeing. If insurance won't cover the care, you'll have to pay the whole bill yourself.

Ask whether surgery is needed for this joint

Surgery can make sense for a bad break, full tear, or unstable joint. A lasting ache doesn't always mean you need an operation.

Ask what surgery would repair and which exercises follow it. Ask whether care without an operation could fit your knee or hip.

Joint preservation means care aimed at keeping your joint useful. That phrase doesn't name the treatment, so ask the staff to describe each part.

Sources

1. Tendinopathy is described in the Nature Reviews Disease Primers review as a complex, multifaceted tendon pathology - disorganised collagen fibres, increased microvasculature and sensory nerve ingrowth, dysregulated matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cell apoptosis - most commonly affecting the rotator cuff, the medial and lateral elbow epicondyles, the patellar tendon, the gluteal tendons and the Achilles. The authors state plainly that management consists of exercise and loading programmes, therapeutic modalities and surgery, and that their effectiveness 'remains ambiguous'.

   Millar NL, et al. — Tendinopathy.. Nat Rev Dis Primers, 2021. DOI: 10.1038/s41572-020-00234-1.

2. The original heavy-load eccentric calf training study followed 15 recreational athletes (mean age 44.3 years) with chronic Achilles tendinosis who had failed conventional care. After 12 weeks of eccentric training all 15 were back at their pre-injury running level with significantly less pain and calf strength restored to match the uninjured side. A comparison group of 15 similar patients treated conventionally with rest, NSAIDs, shoe changes and physiotherapy had no successes and all were ultimately operated on.

   Alfredson H, et al. — Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.. Am J Sports Med, 1998. DOI: 10.1177/03635465980260030301.

3. In 25 randomised trials covering 26,610 participants and 3,464 injuries, STRENGTH TRAINING reduced sports injuries to less than a third (RR 0.315, 95% CI 0.207-0.480) and proprioception training roughly halved them (RR 0.550, 0.347-0.869), while STRETCHING showed no protective effect at all (RR 0.963, 0.846-1.095). Overuse injuries specifically were nearly halved by exercise programmes (RR 0.527, 0.373-0.746).

   Lauersen JB, et al. — The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.. Br J Sports Med, 2014. DOI: 10.1136/bjsports-2013-092538.

4. Across 41 randomised trials and 2,672 participants, corticosteroid injection reduced tendinopathy pain in the SHORT term but the effect reversed later. For lateral epicondylalgia, corticosteroid had a large short-term effect versus no intervention (SMD 1.44, 95% CI 1.17-1.71), but no intervention was FAVOURED at intermediate term (SMD -0.40, -0.67 to -0.14) and long term (-0.31, -0.61 to -0.01). Of 991 participants injected with corticosteroid in trials reporting adverse events, one (0.1%) had a tendon rupture. Platelet-rich plasma was not more efficacious than placebo for Achilles tendinopathy in the trials available at that time.

   Coombes BK, et al. — Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.. Lancet, 2010. DOI: 10.1016/S0140-6736(10)61160-9.

5. The updated evidence-based ankle sprain guideline states that ligament damage severity is assessed most reliably by DELAYED physical examination 4-5 days after the injury; that after a short period of immobilisation the patient benefits most from tape or a brace combined with an exercise programme; that NSAIDs may reduce pain and swelling but are not without complications and MAY SUPPRESS THE NATURAL HEALING PROCESS; that supervised exercise-based programmes are preferred over passive modalities; that surgery should be reserved for cases not responding to comprehensive exercise-based treatment; and that ankle braces are efficacious for preventing recurrence.

   Vuurberg G, et al. — Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.. Br J Sports Med, 2018. DOI: 10.1136/bjsports-2017-098106.

6. The American Medical Society for Sports Medicine's position statement on regenerative medicine exists precisely because the field has 'produced widely varying opinions' and because regulators, clinicians, scientists, patient advocacy organisations and the media have raised concern about how these products are used. It sets out terminology, the basic science and clinical evidence for orthobiologics, regulatory considerations, and best practices for introducing them responsibly - describing the evidence as growing that CERTAIN products are safe and potentially efficacious, not as settled.

   Finnoff JT, et al. — American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine.. Clin J Sport Med, 2021. DOI: 10.1097/JSM.0000000000000973.

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.