Dr. MELISSA BURMANMDJUN 2026
The Injection Creates the Opportunity. Rehabilitation Determines What Happens Next.
From My Clinic Notebook
One of the questions I hear most often after a PRP procedure is, “Now what?” Sometimes it’s “When can I start physical therapy?” or “Should I just rest and let the injection work?” I understand why patients ask — we’ve just spent an hour discussing the procedure, preparing the PRP, using ultrasound guidance, and carefully placing the injectate. It naturally feels like the hard part is over.
The more I’ve practiced regenerative medicine, the more I’ve realized this is where the real work begins. Patients don’t recover simply because they receive an injection. They recover because the injection creates an opportunity for healing, and everything that follows — how they move, load the tissue, sleep, and rehabilitate — determines whether that opportunity is fully realized.
That realization changed my conversations. I spend less time describing PRP as a procedure and more time explaining it as the first step in a coordinated recovery process. The biology begins with the injection, but the biomechanics begin the moment the patient leaves the office.
What We Know
Rather than asking whether PRP or physical therapy is more important, a better question is how each contributes to healing. One influences the biology of injured tissue; the other teaches that tissue how to function again.
We spend years telling patients to reduce inflammation, then intentionally perform a procedure that creates it. During this early phase, platelets release signaling molecules that recruit repair cells. Aggressive loading too soon may interfere with those processes, so my protocols intentionally protect the treated tissue for the first two weeks while the biologic response unfolds, before introducing progressive mechanical stress.
Once the initial inflammatory phase passes, rehabilitation becomes essential. Tendons don’t regain strength just because collagen has been produced — that collagen must align, remodel, and adapt to increasing demand. Progressive loading provides that stimulus. Our protocols move from pain-free isometrics and mobility to strengthening, neuromuscular control, eccentric loading, and eventually sport- or work-specific activity — driven by biology, not the calendar.
A degenerative Achilles tendon should not be rehabilitated like an arthritic knee. Tendons require patience and carefully progressed loading; joints often benefit from earlier restoration of motion followed by strengthening and neuromuscular retraining. In both, the goal extends beyond the site of injury — we’re restoring the entire movement system. Personalized medicine doesn’t end with selecting the right procedure; it continues through the right rehabilitation strategy.
For years regenerative medicine was framed as a choice between procedures and therapy. I don’t think that’s the right conversation anymore. Orthobiologics may create the biologic conditions for healing; rehabilitation provides the mechanical signals that shape how tissue remodels over time. The science supporting this integrated approach keeps growing, and I suspect we’ll spend less time asking which is superior and more time learning how to combine them.
Question to Consider
If we accept that biology and biomechanics are partners in recovery, should we spend as much time designing the rehabilitation plan as we do selecting the procedure itself?
Medicine is constantly evolving. So are the questions worth asking. I’ll keep sharing what I’m learning — from research, from colleagues, and from the patients who continually remind me that good medicine begins with curiosity. If this perspective resonates with you, I’d be honored to have you join me for the next edition.