Start with the simplest care that fits

Small changes can calm the soreness

Ease the movement that keeps raising the ache. You won't always need complete rest. Shorter walks may suit a sore knee. Reaching lower can give a shoulder time to settle.

Too much rest can leave you weaker.

Keep movements that feel safe and steady. Don't force sharp soreness. Heat or cold may help for a while. Ask your doctor which medicines are safe with yours.

Guided exercise rebuilds useful strength

A tendon needs some work to stay strong. Too much can keep it sore. A therapist can match each exercise to your strength. The work gets harder as you improve.

This kind of care takes time.

Some plans include therapist visits and home exercise for 12 weeks. Your timing may differ. The soreness should stay manageable as strength returns. If it keeps rising, ask for an exercise review.

When soreness doesn't settle, QC Kinetix can review it

QC Kinetix offers a clinic exam with medical providers, the health workers who examine you and prepare care. Bring your scan report and notes on past care. They'll tell you if a different kind of care makes more sense.

Regenerative treatments are blood-based options prepared at the clinic.

They'll take some blood and use a machine to separate it. The machine gathers more of the parts called platelets. PRP, which means platelet-rich plasma, is the prepared blood liquid. They'll then place it at the sore joint or tendon. PRP can also be concentrated, with more platelets in the liquid.

Biologic therapies and orthobiologics are names for these blood-based choices. QC Kinetix may discuss them after your exam. With joint preservation, you'd try non-surgical care before choosing knee or hip surgery. These surgery alternatives won't suit everyone.

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. 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.

4. Sixty patients with chronic lateral epicondylitis were randomised 1:1:1 to a blinded injection of platelet-rich plasma, saline or glucocorticoid. At the three-month primary endpoint NEITHER PRP NOR GLUCOCORTICOID BEAT SALINE (PRP vs saline -2.7, 95% CI -8.8 to 3.5; glucocorticoid vs saline -3.8, -9.9 to 2.4). Glucocorticoid did reduce pain more than both at one month, and reduced Doppler activity and tendon thickness at three months.

   Krogh TP, et al. — Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial.. Am J Sports Med, 2013. DOI: 10.1177/0363546512472975.

5. The ATM trial randomised 240 adults at 24 sites with chronic midportion Achilles tendinopathy to a single intratendinous PRP injection or a sham injection. At six months the VISA-A scores were 54.4 versus 53.4 (adjusted mean difference -2.7, 95% CI -8.8 to 3.3), against a minimal clinically important difference of 12 points. Injection-site discomfort was more common after PRP (97 vs 73 patients). The authors state the findings do not support the use of PRP for this condition.

   Kearney RS, et al. — Effect of Platelet-Rich Plasma Injection vs Sham Injection on Tendon Dysfunction in Patients With Chronic Midportion Achilles Tendinopathy: A Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.6986.

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.

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.

9. 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.