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Patient aftercare instructions

After a PRP Injection: Recovery Time, Walking, Worse Pain, and Anti-Inflammatories

The first days, weeks and months after a platelet-rich plasma (PRP) injection into a tendon or joint, with the evidence behind each instruction and an honest note where none exists.

Questions? (646) 290-6660, 24/7

Modal Pain Management · Dr. Alex Movshis, MD

After a PRP Injection: Recovery Time, Walking, Worse Pain, and Anti-Inflammatories

Questions or problems, any hour: (646) 290-6660. Emergency: call 911 or go to the nearest emergency room.

Full guide:
modalpain.com/aftercare/
prp-injection/
Dr. Alex Movshis
Written and medically reviewed by Dr. Alex Movshis, MD Board-certified in pain medicine and anesthesiology · Last reviewed

At a glance

  1. The day of the injection

    • Walk out of the office and walk normally at home. You do not need bed rest.
    • No ibuprofen, naproxen, aspirin for pain, or other anti-inflammatory for 2 weeks. Acetaminophen (Tylenol) is fine.
    • Aspirin or a blood thinner: follow the plan we made with you before the procedure. Do not stop or change it on your own.
    • A shower is fine. Skip baths, hot tubs and pools until tomorrow.
    • Ice for 15 to 20 minutes at a time if the area is sore.

  2. Days 1 to 7

    • Soreness, stiffness or swelling for several days is common, and it can be worse than before the injection. It is not a sign that the injection failed.
    • Use the treated area for ordinary daily activity. No running, jumping, heavy lifting or sport for the first week.
    • Gentle range of motion and stretching are fine after the first 2 days.

  3. Weeks 2 to 6

    • Start or restart the strengthening program from your physical therapist.
    • After 2 weeks, anti-inflammatories are allowed again if you need them, though acetaminophen is still the first choice.
    • Build back to running, sport or heavy work over weeks 4 to 6, guided by the pain.
    • Avoid a cortisone injection in the same spot unless we have discussed it.

  4. Months 3 to 6

    • Judge the result at 3 months and again at 6. Tendons especially can take that long.
    • Bring notes on pain and what you can do now to your follow-up visit.
    • Pain still worse than before the injection after the first week? Book an earlier follow-up rather than waiting.

Call 911 or go to the nearest emergency room for

  • The injected joint turns hot, red and swollen, with pain that keeps getting worse, especially with fever or chills
  • Redness spreading out from the injection site, with fever or chills
  • Trouble breathing, swelling of the lips or throat, or hives spreading over the body

Call us at (646) 290-6660, day or night, for

  • Swelling, warmth or redness of the treated area, even without a fever
  • Numbness, tingling or weakness beyond the treated area that is still there the next morning
  • A large or growing bruise where the blood was drawn
  • Any question about your aspirin or blood thinner plan

The day after a PRP injection, a lot of people feel worse than they did before it. The tendon aches more, or the knee is stiff and puffy. It is the most common call we get after PRP, and it rarely means anything went wrong. PRP is not a painkiller and it is not an anti-inflammatory. It works, when it works, over months, and the first week often hurts.

These are the instructions Dr. Alex Movshis gives patients after an image-guided platelet-rich plasma (PRP) injection into a tendon or joint at Modal Pain Management, with the evidence behind each one and a plain note wherever no study exists. There is a lot of the second kind. If you had PRP somewhere else, the timeline below still applies, but follow your own physician’s instructions where they differ.

Why pain can be worse after a PRP injection

A cortisone injection quiets inflammation. PRP does close to the opposite. It puts a concentrated dose of your own platelets into a tendon or joint, and platelets release signaling molecules that set off a local inflammatory response. Soreness for a few days is the predictable result.

How often, and how long, depends on where the PRP went and what kind it was.

  • Joints. Across 32 knee trials with 1,268 PRP-treated knees, mild pain or swelling followed in about 1 in 10 treated knees. It was more common than after a hyaluronic acid (gel) injection, but only when the PRP was leukocyte-rich, meaning it kept the white blood cells. No severe adverse events were reported in any group (Nakagawa 2026). We use leukocyte-poor PRP. In one trial the authors described the reaction as settling within a few days (Filardo 2012).
  • Tendons. Tendons can stay sore longer. In a randomized trial of needle tenotomy with or without leukocyte-rich PRP, pain was still higher in the PRP group at six weeks, and the difference was gone by one and two years (Kirschner 2021). Across foot and ankle trials, treatment-site pain was reported in 15.1% of patients given PRP and 10.2% of those given other treatments (Fucaloro 2025).

So pain at one week, or even at three weeks after a tendon injection, is not a verdict. If the pain is still worse than before the injection after the first week, book an earlier follow-up visit rather than waiting for the three-month check. A joint that becomes hot, red and swollen, or a fever, is not part of the expected course at all. Those get a call, and the most serious of them get the emergency room, as described below.

Ibuprofen, naproxen and aspirin after PRP

Avoid anti-inflammatory pain relievers for 2 weeks before the injection and 2 weeks after it. That means ibuprofen (Advil, Motrin), naproxen (Aleve), aspirin taken for pain, diclofenac, meloxicam and celecoxib. Acetaminophen (Tylenol) is fine at any time.

Here is the honest basis for that rule. Anti-inflammatories block an enzyme that platelets use to activate. In laboratory studies, platelets from people taking them aggregated less (Schippinger 2015), and a week of naproxen lowered two growth factors in PRP by about 45%, both recovering after a week off the drug (Mannava 2019). What nobody has shown is that this changes how well PRP works in patients. A review of the evidence found no human outcome studies at all (Magruder 2021). Published practice varies widely. A European expert consensus on knee PRP suggests two weeks without anti-inflammatories before the injection and one week after it (Laver 2024), tendon protocols most often restricted them for more than two weeks afterwards (Townsend 2020), and knee trial protocols range from a day to more than a month (Park 2025). With no trial to settle the question, we follow the published protocols: two weeks before and two weeks after. It is a precaution, not a proven rule.

The two weeks before the injection matter because the blood drawn that day carries whatever your platelets have been exposed to. The effect of ibuprofen on platelets wears off within about a day of the last dose (Goldenberg 2005), but after a week of naproxen, the growth factors took a week off the drug to recover (Mannava 2019). Two weeks covers both with room to spare.

Prescribed aspirin and blood thinners are decided one patient at a time. If you take low-dose aspirin, clopidogrel or an anticoagulant for your heart, a stent, a stroke or a clot, the plan for it is made with you, and with the doctor who prescribed it when needed, before the procedure. The evidence pulls in both directions. A review found no evidence that antiplatelet drugs reduce the benefit of PRP (Magruder 2021), while a European consensus lists antiplatelet therapy as a relative reason not to do PRP (Laver 2024). Anticoagulants were not studied, and stopping any of these drugs carries real risk. Follow the plan we made. Do not stop or change the drug on your own.

Activity, exercise and physical therapy after PRP

No trial has compared resting with early activity after PRP for tendons (Townsend 2020), and knee arthritis trials report their protocols too inconsistently to compare (Park 2025). What exists is a record of what the trials asked patients to do, and the instructions below follow the most common of those protocols.

In a systematic review of tendon PRP protocols, stretching most often started 2 to 7 days after the injection, strengthening within two to three weeks, and full return to activity at four to six weeks. Only 12% of protocols restricted weight-bearing, and bracing was more common in Achilles protocols (Townsend 2020). Knee arthritis trials restricted weight-bearing somewhat more often. About a quarter did, for anywhere from 10 minutes to 2 weeks (Park 2025). In the 288-patient RESTORE trial, the knee was moved passively through bending and straightening five times, then patients rested for 10 minutes before going home (Bennell 2021).

That gives our sequence.

  • The injection day and the next day. Walk and use the area for ordinary daily tasks. No running, jumping, heavy lifting, sport or long gym sessions.
  • Days 3 to 7. Gentle range of motion and stretching. Still no hard loading.
  • Weeks 2 to 3. Start or restart the strengthening program from your physical therapist.
  • Weeks 4 to 6. Build back to running, sport or heavy work, guided by pain. A little soreness during loading is acceptable. Pain that is worse the next morning means back off for a few days.

Exercise is part of the treatment, not a threat to it. In the trials of PRP for Achilles and patellar tendon pain, patients in both arms did a structured loading program, and PRP added nothing over a saline injection (de Vos 2010, Scott 2019). If you do not have a physical therapist, ask us for a referral at the follow-up visit.

Ice, heat, showering, driving and the small questions

We found no study on ice, heat, bathing, driving or return to work after PRP. These instructions come from first principles.

Ice for 15 to 20 minutes at a time is fine for soreness, with a cloth between the ice and the skin. Some trials told patients to use it (Filardo 2012). Heat is not known to change the result, so use it if it helps a stiff tendon after the first day. Shower the same evening, but skip baths, hot tubs and pools until the next day so the needle site is not soaked. Driving is usually fine once the treated arm or leg feels normal. Arrange a ride if your right leg or foot was injected and is too sore to brake hard, or if you felt faint at the blood draw. Short-lived nausea or dizziness was reported in about a fifth of patients after a single injection in one knee trial (Patel 2013). Desk work is fine the next day. Physical jobs follow the activity schedule above.

Caffeine, alcohol and supplements come up often, mostly from cosmetic PRP clinics. We found no evidence that caffeine, a moderate amount of alcohol, or a multivitamin changes the result of a tendon or joint injection.

Infection: rare, and the reason for the warning signs

There is no reliable figure for how often PRP causes an infection, because the trials are too small to measure something this rare. Across the pooled knee trials, no severe adverse events were reported in 1,268 PRP-treated knees (Nakagawa 2026). Single cases do occur, including a joint infection that showed itself three days after a knee PRP injection (Toraman 2022).

The signs are the same as after any joint injection. The joint becomes hot, red and swollen, and the pain keeps getting worse rather than settling, often with fever or chills. That goes to the emergency room the same day.

Restarting blood thinners

If your aspirin or blood thinner was paused, restart it on the schedule you were given, not on a general rule from the internet. Joint and soft-tissue injections are classed as low-risk procedures in the multisociety guideline on pain procedures in patients taking blood thinners, but the right timing still depends on the drug and the reason you take it (Narouze 2018). That is why this page gives no drug-by-drug timings. If you are not sure, call us before the next dose.

When to go to the emergency room

For any of the emergency signs on this page, call 911 or go to the nearest emergency room. Do not call the office first. Tell the emergency team that you had a PRP injection, where, and on what date. The signs are a joint that turns hot, red and swollen with pain that keeps getting worse, especially with fever or chills, redness spreading from the injection site with fever or chills, and trouble breathing, swelling of the lips or throat, or hives spreading over the body.

Judging whether PRP worked, and what happens next

Give it three months, and look again at six. The trials show why. In the 230-patient tennis elbow trial, tendon needling with PRP and needling alone were no different at 12 weeks, and the PRP group was ahead at 24 weeks (Mishra 2014). In gluteal tendon pain, PRP and cortisone were level at 2 and 6 weeks, and PRP was ahead at 12 weeks (Fitzpatrick 2018). Knee arthritis can respond sooner. In one placebo-controlled trial, improvement appeared within two to three weeks (Patel 2013).

We also owe you an honest picture of the evidence, because it is mixed. For knee and hip arthritis, the American College of Rheumatology recommends against PRP (Kolasinski 2020), and a placebo-controlled knee trial of 288 patients found PRP no better than a saline injection at 12 months (Bennell 2021). For tennis elbow, a 2026 analysis of placebo-controlled trials found no benefit over placebo (Antunes Júnior 2026), and for gluteal tendon pain on the outside of the hip, a 79-patient double-blind trial found PRP no better than saline (Atchia 2025). Other trials and reviews are more positive, which is why we offer PRP to selected patients and tell them plainly when it is not working.

What to note for your follow-up visit:

  • what share of the familiar pain is gone, as a rough percentage
  • what you can do now that you could not before, such as walking farther, gripping, climbing stairs or sleeping on that side
  • whether the exercise program happened, and how often

Those notes decide the next step. For knee arthritis, a series can do more than a single injection. A review of seven trials found three injections better than one for pain at 12 months (Tao 2023). For tendons, most of the trials described above used a single injection (Mishra 2014, Fitzpatrick 2018, Scott 2019). If there is no real change at three to six months, the next step is usually not more PRP, and the routes below are the ones we look at first.

The PRP therapy page explains which conditions we treat with PRP, what the evidence shows for each, and what it costs.

If PRP did not help: what that usually means

A PRP injection that changes nothing after 3 to 6 months is useful information, wherever it was done. These are the patterns we see most often when patients come in for a second opinion after PRP elsewhere. Bring your imaging and the procedure note, including the PRP system used if you know it.

Knee: arthritis pain that PRP did not change, and you are not ready for a knee replacement

Usually: Knee osteoarthritis that needs a different approach than injections into the joint

At Modal Pain: Genicular nerve block, then radiofrequency ablation if the block works

Hip: pain on the outside of the hip, worse lying on that side or climbing stairs

Usually: Greater trochanteric pain syndrome (gluteal tendon pain or hip bursitis)

At Modal Pain: Ultrasound-guided injection at the tendon, paired with a loading program

Elbow: the tendon pain is the same months later, and the exercise program stopped early

Usually: A tendinopathy that has not had a full loading program

At Modal Pain: A supervised progressive loading program, which is the core treatment for tendon pain

Shoulder: weakness lifting the arm, or night pain that PRP did not change

Usually: A rotator cuff tear or subacromial pain that needs imaging and a different plan

At Modal Pain: Ultrasound examination, then the injection or referral that matches the finding

Modal Pain Management accepts most commercial PPO plans, including Aetna, Anthem Blue Cross Blue Shield, Cigna, Empire Blue Cross Blue Shield, the Empire Plan, Oscar, Oxford, UMR and UnitedHealthcare, and does not accept Medicare, Medicaid, HMO plans, or workers' compensation. Our office handles prior authorization. Most insurers do not cover PRP itself, and our self-pay prices are published. Insurance details · Self-pay pricing

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Frequently asked questions

Right away, in almost every case. Walk out of the office and walk around at home. What waits is hard use: running, jumping, heavy lifting and sport. No study has compared rest with early activity after a tendon PRP injection (Townsend 2020). In the published knee arthritis trials, about a quarter of protocols limited weight-bearing, for anywhere from 10 minutes to 2 weeks (Park 2025), and the large RESTORE trial simply moved the knee passively a few times and had patients rest for 10 minutes (Bennell 2021).

Expect a few sore days, a week of lighter use, and a return to full activity over four to six weeks, which is the most common return-to-activity window in tendon PRP protocols (Townsend 2020). Recovery from the injection and the result of the injection are on different clocks. The result takes 3 to 6 months to judge.

Because PRP often hurts for a while before it helps. In pooled knee trials, about 1 in 10 knees had pain or swelling after PRP, more often with leukocyte-rich preparations (Nakagawa 2026). In a tendon trial, pain was still higher with PRP than without it at six weeks, and the difference was gone by one year (Kirschner 2021). Worse pain in the first week or two is expected. If the pain is still worse than before the injection after the first week, come back for an earlier follow-up. A hot, red, swollen joint is different, and needs a call right away.

For 2 weeks after the injection, and ideally for 2 weeks before it as well. Anti-inflammatories such as ibuprofen and naproxen act on platelets, and in laboratory studies they reduced platelet function and some growth-factor levels in PRP (Schippinger 2015, Mannava 2019). Whether that changes the clinical result has never been tested in patients (Magruder 2021). Our two-week pause follows published protocols (Laver 2024, Townsend 2020). It is a precaution, not a proven rule. Acetaminophen (Tylenol) is fine at any time.

We found no study showing that caffeine or a moderate amount of alcohol after the injection changes the result. A European consensus suggests skipping alcohol for 48 hours before the blood draw, based on expert opinion rather than trials (Laver 2024). A night of heavy drinking is still a poor idea when you are sore and need to move carefully.

Gentle range of motion after two days, the strengthening program from your physical therapist from about week two, and running, sport or heavy lifting built back over weeks four to six. That sequence follows the most common published tendon protocols (Townsend 2020). Exercise is part of the treatment, not a risk to it. In the Achilles and patellar tendon trials, patients in both arms did a loading program, and PRP added nothing over a saline injection (de Vos 2010, Scott 2019).

Not in the same spot without talking to us first. A European consensus on knee PRP advises against giving the two close together and suggests at least 6 weeks after a cortisone shot (Laver 2024). The large RESTORE trial excluded anyone who had cortisone in the previous 3 months (Bennell 2021). Cortisone elsewhere in the body, such as in your back, is a separate question.

References

Every figure on this page comes from the sources below. Where no study exists, the page says so and explains the reasoning instead.

  1. Townsend C, Von Rickenbach KJ, Bailowitz Z, et al. Post-procedure protocols following platelet-rich plasma injections for tendinopathy: a systematic review. PM R. 2020. doi:10.1002/pmrj.12347 · PubMed
  2. Park AL, Bailowitz ZP, DeJong PM, et al. Postinjection protocols following platelet-rich plasma injection for knee osteoarthritis: a systematic review of randomized controlled trials. J Cartil Jt Preserv. 2025. doi:10.1016/j.jcjp.2024.100201
  3. Bennell KL, Paterson KL, Metcalf BR, et al. Effect of intra-articular platelet-rich plasma vs placebo injection on pain and medial tibial cartilage volume in patients with knee osteoarthritis: the RESTORE randomized clinical trial. JAMA. 2021. doi:10.1001/jama.2021.19415 · PubMed
  4. Nakagawa HF, Kim J, Rabinowitz J, et al. Assessment of adverse events and safety associated with intra-articular platelet-rich plasma injections compared to other injectates for knee osteoarthritis: a systematic review and meta-analysis. PM R. 2026. doi:10.1002/pmrj.70141 · PubMed
  5. Filardo G, Kon E, Di Martino A, et al. Platelet-rich plasma versus hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord. 2012. doi:10.1186/1471-2474-13-229 · PubMed
  6. Kirschner JS, Cheng J, Hurwitz N, et al. Ultrasound-guided percutaneous needle tenotomy (PNT) alone versus PNT plus platelet-rich plasma injection for the treatment of chronic tendinosis: a randomized controlled trial. PM R. 2021. doi:10.1002/pmrj.12583 · PubMed
  7. Fucaloro SP, Berhane M, Mulvey M, et al. Platelet-rich plasma injections for foot and ankle pathologies have significantly more complications compared with hyaluronic acid injections, saline solution injections, and dry needling: a systematic review. Arthroscopy. 2025. doi:10.1016/j.arthro.2025.03.065 · PubMed
  8. Schippinger G, Prüller F, Divjak M, et al. Autologous platelet-rich plasma preparations: influence of nonsteroidal anti-inflammatory drugs on platelet function. Orthop J Sports Med. 2015. doi:10.1177/2325967115588896 · PubMed
  9. Mannava S, Whitney KE, Kennedy MI, et al. The influence of naproxen on biological factors in leukocyte-rich platelet-rich plasma: a prospective comparative study. Arthroscopy. 2019. doi:10.1016/j.arthro.2018.07.030 · PubMed
  10. Magruder M, Rodeo SA. Is antiplatelet therapy contraindicated after platelet-rich plasma treatment? A narrative review. Orthop J Sports Med. 2021. doi:10.1177/23259671211010510 · PubMed
  11. Goldenberg NA, Jacobson L, Manco-Johnson MJ. Brief communication: duration of platelet dysfunction after a 7-day course of ibuprofen. Ann Intern Med. 2005. doi:10.7326/0003-4819-142-7-200504050-00009 · PubMed
  12. Laver L, Filardo G, Sanchez M, et al. The use of injectable orthobiologics for knee osteoarthritis: a European ESSKA-ORBIT consensus. Part 1 - blood-derived products (platelet-rich plasma). Knee Surg Sports Traumatol Arthrosc. 2024. doi:10.1002/ksa.12077 · PubMed
  13. Mishra AK, Skrepnik NV, Edwards SG, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014. doi:10.1177/0363546513494359 · PubMed
  14. Fitzpatrick J, Bulsara MK, O'Donnell J, et al. The effectiveness of platelet-rich plasma injections in gluteal tendinopathy: a randomized, double-blind controlled trial comparing a single platelet-rich plasma injection with a single corticosteroid injection. Am J Sports Med. 2018. doi:10.1177/0363546517745525 · PubMed
  15. Patel S, Dhillon MS, Aggarwal S, et al. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013. doi:10.1177/0363546512471299 · PubMed
  16. de Vos RJ, Weir A, van Schie HT, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010. doi:10.1001/jama.2009.1986 · PubMed
  17. Scott A, LaPrade RF, Harmon KG, et al. Platelet-rich plasma for patellar tendinopathy: a randomized controlled trial of leukocyte-rich PRP or leukocyte-poor PRP versus saline. Am J Sports Med. 2019. doi:10.1177/0363546519837954 · PubMed
  18. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020. doi:10.1002/art.41142 · PubMed
  19. Antunes Júnior CR, Santos RSS, Barreto ESR, et al. Platelet-rich plasma does not improve pain or function in lateral epicondylitis compared with placebo: a meta-analysis. Am J Sports Med. 2026. doi:10.1177/03635465251383039 · PubMed
  20. Atchia I, Ali M, Oderuth E, et al. Efficacy of platelet-rich plasma versus placebo for the treatment of greater trochanteric pain syndrome: a double-blinded randomized controlled trial. J Bone Joint Surg Am. 2025. doi:10.2106/JBJS.24.00763 · PubMed
  21. Tao X, Aw AAL, Leeu JJ, et al. Three doses of platelet-rich plasma therapy are more effective than one dose of platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthroscopy. 2023. doi:10.1016/j.arthro.2023.05.018 · PubMed
  22. Narouze S, Benzon HT, Provenzano D, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition). Reg Anesth Pain Med. 2018. doi:10.1097/AAP.0000000000000700 · PubMed
  23. Toraman NF, Karadağ Özdemir A, Bilgilisoy Filiz M, et al. Streptococcus mitis septic arthritis after leucocyte-rich platelet-rich plasma injection for the knee osteoarthritis: a case report. Turk J Phys Med Rehabil. 2022. doi:10.5606/tftrd.2022.7175 · PubMed

These are general instructions after a platelet-rich plasma (prp) injection. If the instructions you were given at discharge differ, follow the ones you were given, because they account for your medications and your procedure. For anything you are unsure about, call (646) 290-6660. See the platelet-rich plasma (prp) injection page for how the procedure works and who it helps, or the aftercare instructions for other procedures.

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