Chronic buttock pain? Trouble lying on your side at night because of pain? Difficulty climbing stairs? Most often, this is a gluteal tendon problem – affecting the gluteus medius and/or gluteus minimus tendons. The tendon can become inflamed, degenerative and start to tear. It commonly affects individuals over 40 years old and affects women more than men (8).

Most people think their “hip joint” or a “bursitis” is the problem. However, a recent ultrasound study showed that most cases of buttock/lateral hip pain are in fact due to a gluteal tendon problem (9). Bursitis occurs in only a minority of cases. This can be diagnosed with an in-office ultrasound.

If the gluteal tendons are damaged, treatment usually starts with physical therapy, activity modification and anti-inflammatory medications. However, these results can be inconsistent (10). In these instances, a platelet rich plasma (PRP) injection can be very helpful. Compared with a cortisone injection, an ultrasound guided injection of PRP into the tendon can provided superior relief at 12 weeks (11). Moreover, these results can be long lasting. A more recent 2019 study showed the positive results of a PRP treatment can last up to 2 years or more (12).

Sprinting and had to pull up because of pain? Feel a pop or bruising? Hamstring tears, both acute and chronic, are very common in sports with sudden acceleration and deceleration. Runners, soccer and football players are often affected. A big fall during waterskiing is also a classic injury pattern. The hamstring is composed of 3 muscle groups: biceps femoris, semimembranosis and semitendinosis. These 3 muscles originate from a common tendon that comes off the bone you sit on, the ischial tuberosity. Your hamstring helps you flex your knee and extend your hip.

Hamstring injuries can range from a mild strain, to an avulsion fracture where the tendon pulls away the bone. An ultrasound, xray and/or MRI is helpful to determine the severity.

After a hamstring injury, a good exercise program is important in your recovery. It should include a stretching and gradually progressive eccentric strengthening component.  If your progress has plateaued or need a quicker recovery, a platelet rich plasma (PRP) injection might make all the difference. A randomized control trial comparing physical therapy alone vs physical therapy plus a PRP injection, showed athletes can recover on average 2 weeks sooner (14).

The patellar tendon is a frequent cause of pain below the knee cap. Commonly called “jumper’s knee”, this affects jumping athletes, such as volleyball and basketball players. These stubborn injuries are often missed and go undiagnosed leading to compounded problems. A simple in-office ultrasound can make the diagnosis.

Treatment strategies include load management, addressing biomechanical factors such as gluteal tendon weakness, patellar straps, extracorporeal shockwave therapy and eccentric loading programs. However, some athletes have persistent pain despite these interventions.

Recent studies have shown that platelet rich plasma (PRP) injections can be extremely helpful.  A systematic review and metanalysis including over 2000 patients concluded that when treating patellar tendinopathy “exercise is an effective strategy to obtain the best short-term results, but multiple PRP injections offer better results after 6-months follow-up, which remain stable at long-term follow-up” (13)

Nagging pain on the outside of your elbow? Difficulty lifting a bag of groceries or typing for a long time? Tennis elbow (lateral epicondylitis) is often a repetitive strain injury that can be settled with stretching, activity modification, a good physiotherapy program and shockwave therapy. But sometimes these stubborn injuries persist. A platelet rich plasma (PRP) injection often cures this issue and has been shown to be the best treatment in some cases (15).

PRP, in fact, has been shown to be one of the more effective strategies for treating this kind of tendon injury. Double-blinded, randomized control trials have shown that compared to a cortisone injection, a platelet rich plasma injection (PRP) is far superior for encouraging healing and a permanent solution. Studies have shown continued improvement for 1-2 years after a single injection (16,17).