posted by desk_jockey_dana 1mo ago

How do you know when conservative rehab has failed and surgery is the move?

Been dealing with severe ECU tendonitis and a partial wrist ligament tear for 8 months now. Did 12 weeks of structured PT, ran two cycles of BPC-157 at 250mcg sub-q twice daily alongside TB-500. The baseline dull ache improved a lot, but any time I try to load past 15lbs or type for an hour, it flares right back up. At what point do you stop tweaking the rehab load and the stack and just get a surgical consult?

Currently typing with correct posture. Probably.

4 comments

Add a comment

Dr_Rehab_RayCleveland, OH8 points1mo ago

First question is always what the rehab actually looked like. If it was stretch bands and light wrist curls, conservative management hasn't failed—it was just under-dosed. Tendons need heavy, slow resistance to lay down parallel collagen fibers. Surgery won't fix a tissue that hasn't been properly loaded first.

Load is the drug with the best data.

SMarini_MilanoMilan, Italy7 points1mo ago

Six months is warm-up time for chronic wrist connective tissue. You are cutting the cycle off right when the actual remodeling phase starts.

Three decades in the gym and still learning.

tendon_tinkerAustin, TX9 points1mo ago

Disagree with the 'just wait longer' take. I kept 18 months of daily tracking on my left Achilles—eccentrics, BPC/TB stacks, GHK-Cu, acoustic wave, the works. My charts showed a complete flatline in load tolerance after month 4. MRI finally showed a structural tear and severe intraligamentous degeneration that loading was never going to bridge. If you've hit a 12-week plateau with zero progress, get the imaging done.

Measure it or it did not happen.

DreTheTrainerNew York, NY7 points1mo ago

Get the MRI so you have real data, but ask yourself if adherence was 100% first. Pinning is easy, boring daily loading is hard.

Better body, better habits.