Which treatment choices can help my sore joint?

What can I change at home?

Shorten your walk, avoid steep ground, or play fewer games for a while. Keep movements that don't raise the soreness later that day or the next morning.

As the ache settles, add strength and activity a little at a time. A brace may help after repeated ankle sprains when you also do the right exercises.

Don't return to a full week of activity just because one day felt good. Give the joint time to show how it handled the change.

What happens during a regular visit?

The doctor or nurse asks where the ache sits and which motions start it. The exam checks strength, movement, swelling, and spots that hurt when pressed.

Those checks may show whether a muscle, tendon, bone, or the joint itself is sore. Sometimes an X-ray or another test is needed before the cause is clear.

Treatment may include activity changes, home exercises, physical therapy, a brace, or medicine. The choice depends on the exam and the activity you want to resume.

What are PRP and concentrated PRP?

PRP means platelet-rich plasma: staff take a little blood, spin it to separate the layers, and use the platelet-rich layer for a shot. This is a biologic therapy, meaning the treatment material comes from your blood.

Concentrated PRP contains more platelets in the part prepared for the shot. Results can differ by the sore body part and by how the blood is prepared.

Ask whether you will need home exercises or physical therapy afterward. QC Kinetix offers regenerative treatments for joint soreness, including these blood-based shots, under its Chandler medical team.

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. 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.

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. 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.

5. 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.

6. 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.

7. A meta-analysis of 18 randomised trials (1,066 participants) of PRP for tendinopathy found the largest effects with highly cellular LEUKOCYTE-RICH preparations - pooled SMD 36.38 (95% CI 34.00-38.77) for leukocyte-rich versus 26.77 (18.31-35.22) for leukocyte-poor - and reported that the different control injections (saline, local anaesthetic, corticosteroid, dry needling) produced broadly similar effects to one another. The authors concluded that both the preparation and the ultrasound-guided intratendinous injection technique are of great clinical significance, which is another way of saying that two clinics' PRP are not the same intervention.

   Fitzpatrick J, et al. — The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials.. Am J Sports Med, 2017. DOI: 10.1177/0363546516643716.

8. A systematic review of 105 clinical orthopaedic PRP studies found that only 11 (10%) described the preparation protocol well enough for another investigator to repeat it, and only 17 (16%) gave any quantitative measure of what was actually in the final PRP product. Without that, trials of 'PRP' cannot be meaningfully compared with one another - which is the single largest reason the tendon and joint literature disagrees with itself.

   Chahla J, et al. — A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature.. J Bone Joint Surg Am, 2017. DOI: 10.2106/JBJS.16.01374.

9. A systematic review of extracorporeal shockwave therapy across five lower-limb conditions found MODERATE-level evidence of NO difference between focused shockwave and placebo shockwave at short and mid term in patellar tendinopathy, and moderate-level evidence that radial shockwave beats conservative treatment in proximal hamstring tendinopathy. Everything else was low or very low level: comparable to eccentric training in midportion Achilles tendinopathy, superior to eccentric training at four months in insertional Achilles tendinopathy, and worse than corticosteroid short-term but better mid- and long-term in greater trochanteric pain syndrome. Thirteen studies were at high risk of bias.

   Korakakis V, et al. — The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction.. Br J Sports Med, 2018. DOI: 10.1136/bjsports-2016-097347.