Tennis star Rafael Nadal has been plagued by patellar tendinitis in his knees for at least the last few years. This is despite intensive physical therapy and possibly PRP or another cell based treatment for his tendinitis. This combination of treatments has overall helped him keep playing and to win multiple majors. However currently he is on a 2-3 month hiatus from tennis due to his patellar tendinitis. In doing so he has missed the Olympics and US Open, and will be missing his country’s Davis Cup match against the US. What’s a reasonable way to gauge how well his medical treatment has worked out? He obviously still has chronic tendinitis in his knees. Is it possible to say his regimen actually worked for him? I would say yes. But it also depends on what were the expected outcomes for his treatments.

An essential discussion between physician and patient before any treatment is to discuss what are reasonable expectations of treatment. For a recreational athlete reduction of pain by 70%+ with continued exercise close to his normal level could be a great result. For a professional athlete only 40-50% pain relief with full reinstitution of activity could be considered a satisfactory outcome. And for someone with a chronic severe musculoskeletal issue 30-40% improvement in pain for the first time in years could feel like a minor miracle. Expectations can and should vary between patients.

Lastly it’s important to except that certain treatments just may not work for some people. There are tons of potential variables that can affect the outcome. Severity and duration of a problem, treatment selected, ability of the treating physician, comorbid conditions that patients suffer from, and even certain medications can all play a role. It’s great that existing treatments are better than previous ones, and equally important that newer treatments and methods are coming online that may offer even greater benefit. Frank and clear expectations are important between physicians and patients. That clarity combined with newer and better treatments result in the best possible outcomes.

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