A tendon can remain painful long after the original injury has been forgotten. The first steps out of bed may hurt at the heel, a tennis backhand may provoke the outside of the elbow, or climbing stairs may make the knee feel unreliable. PRP injections for tendinopathy can be a useful option for some people when a tendon has not improved with sensible rehabilitation, but they are not a shortcut or a one-size-fits-all treatment.
The right starting point is a clear diagnosis. Tendon pain can come from several structures around the same area, and the treatment that helps a painful joint, bursa, nerve or muscle may not be the treatment a tendon needs. A thorough clinical assessment, often supported by musculoskeletal ultrasound, helps establish what is driving the pain and whether PRP is a sensible next step.
What is tendinopathy?
Tendons are strong bands of tissue that transfer force from muscle to bone. They allow us to walk, grip, climb stairs, lift, run and reach. Tendinopathy describes persistent tendon pain and changes in tendon structure, usually related to repeated loading that has exceeded the tendon’s current capacity.
It is often called tendonitis, but longstanding tendon problems are not usually simply a matter of inflammation. The tendon may be thickened, irritated and less able to tolerate everyday load. This is why rest alone often does not solve the problem. Complete rest can reduce symptoms briefly, but it may also leave the tendon less prepared for the activity you want to return to.
Common examples include tennis elbow, Achilles tendinopathy, patellar tendinopathy below the kneecap, gluteal tendinopathy at the outer hip and some rotator cuff tendon conditions. Symptoms may build gradually, although a flare can feel sudden after a change in walking, sport, work demands, footwear or training volume.
How PRP injections for tendinopathy work
PRP stands for platelet-rich plasma. It is made from a small sample of your own blood, which is processed to concentrate platelets within plasma. Platelets contain signalling proteins involved in the body’s normal healing response.
The prepared PRP is then injected into or around the affected tendon, usually under ultrasound guidance. Ultrasound allows the clinician to identify the tendon, assess areas of thickening or disruption, avoid nearby structures and place the injection accurately. This matters particularly where tendons sit close to nerves, blood vessels or joints.
The aim is not to instantly numb pain. Unlike a local anaesthetic injection, PRP is intended to support a biological response within a tendon that has struggled to adapt and recover. It is normally paired with a progressive rehabilitation plan, because a tendon also needs carefully graded loading to regain strength and confidence.
PRP is often considered when symptoms have persisted despite appropriate physiotherapy, activity modification and a well-structured loading programme. It may also be considered where ultrasound findings and clinical symptoms point to a focal tendon problem that is suitable for injection treatment.
The evidence is encouraging in some cases, but not identical for every tendon
It is reasonable to want a straightforward answer: will PRP work? The honest answer is that it depends. Research into PRP is evolving, and results vary according to the tendon involved, the length of symptoms, how the PRP is prepared, the injection technique and the rehabilitation used afterwards.
Some people with chronic tendinopathy experience meaningful improvement in pain and function after PRP, particularly when it is delivered precisely and followed by a committed rehabilitation programme. Others improve gradually with exercise alone, while some do not gain enough benefit from PRP to justify repeating it.
This does not mean the treatment lacks value. It means it should be selected carefully. A person with a recent overload flare, for example, may need temporary activity changes and targeted rehabilitation rather than an injection. Someone with a partial tendon tear, major weakness, a joint problem contributing to tendon overload or symptoms caused by a nerve may need a different treatment pathway.
At The Arthritis Clinic, treatment planning is based on your symptoms, examination, functional goals and ultrasound findings, rather than assuming that every painful tendon needs the same injection.
What happens during a PRP appointment?
After discussion and consent, a small blood sample is taken from your arm. It is processed in a centrifuge to prepare the platelet-rich plasma. The skin over the treatment area is cleaned and the tendon is assessed with ultrasound.
The injection itself is performed using ultrasound guidance. You may feel pressure or discomfort as the needle is positioned and PRP is introduced. Some tendon procedures can be more uncomfortable than others, particularly if the tendon is very sensitive. Your clinician will explain what to expect and how the area will be managed during the procedure.
Most appointments allow you to go home the same day. You will receive individual advice on work, driving, exercise and pain relief. It is often sensible to avoid strenuous activity immediately afterwards, but prolonged immobilisation is rarely the goal. The next phase is a planned return to movement and tendon loading.
Recovery after PRP: what should you expect?
A short-term increase in soreness is common after a PRP injection. This can last for several days and occasionally longer, depending on the site and severity of the tendinopathy. It does not automatically mean something is wrong, but worsening pain, marked swelling, fever or other unexpected symptoms should be discussed promptly with your treating clinician.
Improvement is usually measured in weeks and months, not days. The first sign may be that a previously painful task becomes easier, such as walking the dog, holding a pan, getting up from a chair or managing stairs. Tendons adapt slowly, so progress is better judged by function over time than by day-to-day pain alone.
Your rehabilitation may start with tolerable isometric exercises, then progress to strengthening and activity-specific work. For an Achilles tendon, that may include calf loading and a gradual return to hill walking or running. For tennis elbow, it may involve building grip and forearm capacity before returning to racquet sports, DIY or repetitive work tasks.
The plan should fit your life. A keen golfer, a nurse on long shifts and someone caring for grandchildren all place different demands on the same tendon. Good rehabilitation identifies the activities that matter to you and rebuilds capacity towards them.
Who may not be suitable for PRP?
PRP is not appropriate for every painful tendon or every patient. Suitability needs individual clinical assessment. Your clinician will ask about medications, allergies, bleeding or clotting conditions, infection, pregnancy, significant medical conditions and previous treatment. Some medicines can affect platelets or the body’s response to an injection, so do not stop prescribed medication without professional advice.
It is also essential to identify situations that need a different response. Sudden loss of strength, a visible change in tendon shape, an inability to bear weight, a traumatic injury with a popping sensation, fever, unexplained weight loss or a hot, swollen joint should not be treated as routine tendinopathy. These symptoms warrant timely medical assessment.
A corticosteroid injection may sometimes be considered for pain arising from a nearby inflamed bursa or joint, but it is not automatically the best choice for a tendon itself. Repeated corticosteroid injection around certain tendons can carry risks, including reduced tendon integrity. This is another reason why accurate diagnosis matters before treatment is chosen.
Risks and practical trade-offs
Because PRP uses your own blood, serious reactions are uncommon, but no injection is risk-free. Potential risks include temporary pain flare, bruising, bleeding, infection, damage to nearby structures and failure to improve. Ultrasound guidance helps improve procedural precision, but it cannot guarantee an outcome.
There is also a practical trade-off. PRP is a private treatment and recovery requires patience, appointments and active participation in rehabilitation. If you are unable to follow a graded exercise plan or need immediate pain relief for a particular reason, another approach may be more appropriate. A clear discussion of likely benefit, alternatives and expected timescales should come before any decision.
Making a confident decision about treatment
If tendon pain has kept you from walking comfortably, working, exercising or enjoying a valued hobby, you deserve more than generic advice to rest and hope. Ask what structure is causing the pain, whether ultrasound would change the plan, what rehabilitation you have already tried and what result is realistic for your goals.
PRP can be one part of a thoughtful recovery plan, not the whole plan. With a precise diagnosis, image-guided treatment where appropriate and rehabilitation that progresses at the right pace, the focus remains where it should be: helping you move with greater confidence and get back to the life you value.