By Marc Darrow, MD, JD
For a golfer who has spent months avoiding the course because of shoulder pain, being able to swing again can feel like a major turning point. But an important question remains: does feeling better mean the shoulder is ready for a full round?
During my October 3, 2026 Living Pain-Free radio program, a caller named Tom described improvement after a PRP injection for a shoulder problem involving the supraspinatus tendon. He had not played golf since March 30. Twelve days after treatment, he went to the driving range and hit some balls with relatively little pain. The next morning, he reported no stiffness.
That was encouraging. However, Tom was careful to explain that he had hit balls at the range, not played a round of golf. I asked him to return for an examination before increasing his activity.
His experience illustrates a question many patients have after an injection: How do you move from early symptom improvement to a safe return to the activity you enjoy? One caller’s improvement cannot establish the effectiveness of PRP or determine when another person should resume golf.
Why does golf make a shoulder painful?
Repeated swings, changes in practice volume, and a sudden impact with the ground can place different demands on the shoulder. A golfer may first notice discomfort near the end of a practice session, then begin changing the swing to avoid pain. Symptoms can eventually interfere with sleep or ordinary reaching.
The original article discussed the relationship between shoulder symptoms and clubhead speed. A 2013 study of 31 male, right-handed, high-performance amateur golfers found a significant difference in clubhead velocity between golfers with and without clinical signs of shoulder impingement. This small observational study linked shoulder findings with performance; it did not test PRP or show that an injection would restore swing speed. (1)
“Golf shoulder” is a description, not a diagnosis. Rotator cuff tendinopathy, partial tears, biceps tendon problems, labral injuries, arthritis, and instability may produce overlapping symptoms. The useful question is which structure is contributing to pain and which movements expose that problem.
For additional background, see PRP injections for rotator cuff tears: research and reviews and Does a shoulder labrum tear require surgery?.
Is there a standard waiting period after shoulder PRP?
There is no well-established, golf-specific deadline that applies to every shoulder PRP injection. Recommendations depend on the diagnosis, the tissue treated, the procedure, and the shoulder’s response.
A systematic review of 84 studies of PRP for tendinopathy found substantial differences in post-injection instructions. Only 42% described return to play or full activity; among those protocols, four to six weeks was the most commonly reported interval. The studies involved different tendons, and none directly compared rehabilitation protocols. That finding describes published practice; it does not establish that every golfer is ready at four or six weeks. (2)
A 2026 international expert consensus supported progressive rehabilitation and a gradual return to activity guided by clinical findings. It also acknowledged that its recommendations rested largely on expert opinion and low-level evidence. This was guidance for chronic tendinopathy, not a trial establishing a return-to-golf schedule for rotator cuff tears. (3)
Less pain does not prove that a tendon tear has healed
Tom’s report tells us that an activity previously limited by pain had become more comfortable. It does not tell us that his supraspinatus tendon had regained normal structure or strength.
Pain, function, and imaging findings are different outcomes. A shoulder can become more comfortable while a tear remains visible. Conversely, an image alone cannot tell us how confidently someone can control a club through repeated swings.
In discussing a return to golf, I would distinguish the ability to make a comfortable movement from the capacity to repeat that movement under increasing load. A few easy swings, a prolonged practice session, and a full round represent different demands.
The 2026 consensus emphasized clinical examination and sport-specific rehabilitation. It did not recommend routine imaging as a requirement for returning to sport after tendon rehabilitation. That does not make imaging unnecessary when a new injury, unexpected weakness, or an uncertain diagnosis needs investigation. (3)
Which shoulder problem is being treated?
The supraspinatus is one of the four rotator cuff tendons. A partial tear affects part of the tendon’s thickness; a full-thickness tear extends through it. Tendon retraction, muscle changes, and the circumstances of an injury can also affect treatment decisions.
Shoulder symptoms may overlap with biceps tendon pain, bursitis, stiffness, arthritis, or pain referred from the neck. A diagnosis of “impingement” describes a clinical pattern, but does not prove that a bone spur or one compressed structure explains every symptom. A careful examination helps distinguish painful movement from true loss of strength.
The 2025 rotator cuff tendinopathy clinical practice guideline addresses assessment, nonsurgical care, rehabilitation, and return to sport. Its scope includes tendinopathy and partial-thickness tears; it should not be treated as a rehabilitation protocol for every full-thickness tear or postoperative shoulder. (4)
Tom identified a supraspinatus tear during the broadcast, but the conversation did not establish its size, depth, or other imaging characteristics. His story therefore cannot be used to predict outcomes for a particular tear category.
How do cortisone and PRP differ?
Corticosteroid injections are used to reduce inflammation and pain. PRP delivers concentrated platelets and associated signaling proteins. Neither treatment should be judged solely by how quickly it makes a swing more comfortable.
The original page raised concerns about steroid injections before rotator cuff surgery. A systematic review of eight studies found associations between preoperative corticosteroid injections and postoperative infection or revision surgery, with timing and repeated injections affecting the observed risk. The evidence came from observational studies and does not prove that every steroid injection causes tendon damage or a poor surgical outcome. (5)
The diagnosis matters here as well. Research on adhesive capsulitis, or frozen shoulder, cannot automatically establish the benefit of an injection for a rotator cuff tear. Likewise, studies of injections administered during surgical repair answer a different question from studies of nonsurgical PRP treatment.
What does research show about shoulder PRP?
PRP is prepared from a patient’s blood and contains a concentration of platelets. It is different from a bone marrow concentrate injection, and studies of one preparation cannot automatically establish the effectiveness of another.
In a randomized trial involving 99 patients with rotator cuff tendinopathy or partial-thickness tears, PRP produced greater improvement in pain and function than corticosteroid injection at three months. However, the groups did not differ significantly at six weeks or 12 months, and PRP did not significantly reduce treatment failure or conversion to surgery. The study supports a possible short-term benefit in selected patients, not a guaranteed result. (6)
A 2026 randomized trial studied 63 patients with isolated partial supraspinatus tears on the joint-facing side of the tendon. Participants received physiotherapy alone or physiotherapy plus two ultrasound-guided PRP injections. The combined-treatment group had a greater reduction in tear volume and greater improvement in shoulder function. Both groups improved clinically. (7)
These findings are encouraging, but they concern a defined patient group and a specific combination of injections and rehabilitation. They do not establish complete tendon restoration, apply to every rotator cuff tear, or demonstrate that golf is safe 12 days after treatment.
How might a gradual return to golf be approached?
The practical goal is to rebuild tolerance for golf rather than use a single painless swing as the test of recovery.
Once activity has been cleared, a progression might move from lower-demand practice to partial swings, then to fuller swings and longer sessions. Putting, chipping, iron practice, and driver practice place different demands on the shoulder. The order and pace should reflect the injury and the treating clinician’s instructions.
These are examples of increasing golf exposure, not a validated PRP rehabilitation protocol. Relevant questions include whether the shoulder has adequate motion and strength, whether the swing provokes symptoms, and whether pain or stiffness increases afterward or the next morning.
The 2026 consensus supported including exercises specific to the patient’s sport in the final rehabilitation phase. Its recommendations also considered symptoms during exercise and over the following 24 hours. The general principle is useful: the response after a session matters alongside how the shoulder feels while performing it. (3)
Does persistent pain mean you need a stem cell injection?
Not necessarily. Tom asked whether a cell-based treatment might be considered if PRP did not provide complete improvement. Persistent symptoms first raise the question of what remains painful and whether the diagnosis or activity demands need reassessment.
Bone marrow concentrate contains a mixture of cells and signaling components, including a small population of mesenchymal stromal cells. It is not a purified or culture-expanded MSC product.
A 2024 randomized crossover trial enrolled 51 patients with selected non-retracted supraspinatus tears. Bone marrow concentrate combined with platelet products produced greater improvement than home exercise at three months. The treatment involved several components, however, so the study cannot isolate the effect of the marrow-derived cells. Crossover and subsequent treatments also complicate interpretation of longer-term comparisons. (8)
The trial’s rehabilitation restrictions were lifted after 12 weeks, followed by a gradual return to activity. That was a study-specific bone marrow and platelet-product protocol—not a timetable to transfer to Tom’s PRP treatment. (8)
### Our published shoulder research
In our 2019 study, 47 patients with 50 treated shoulders affected by rotator cuff tears or osteoarthritis received one or two bone marrow concentrate or whole bone marrow treatments. Patients reported improvements in resting pain, activity-related pain, and function. The groups receiving one and two treatments reported average overall improvement of approximately 42% and 50%, respectively. (9)
This was an uncontrolled analysis of clinical outcomes, not a randomized comparison. It did not establish that two treatments are superior for every patient, demonstrate complete tendon regeneration, or determine a safe return-to-golf date. Its value is as preliminary evidence that warrants further controlled study.
The marrow preparations in this study and the 2024 trial were not culture-expanded stem cell products. Their results also cannot be transferred to donor umbilical cord, Wharton’s jelly, or exosome products. Those are different preparations requiring their own clinical evidence.
More information about partial tears appears in Partial supraspinatus tendon tears.
When should shoulder symptoms be reassessed?
A sudden loss of strength after an injury, inability to raise the arm, or a marked deterioration deserves evaluation rather than continued swing practice. Fever, spreading redness, or escalating pain after an injection also requires prompt medical attention.
Residual pain does not automatically mean an injection has failed, and early improvement does not automatically mean recovery is complete. For Tom, the useful next step was to examine the shoulder before increasing golf activity.
The decision to return to golf should reflect the condition of the shoulder and its ability to tolerate the sport—not simply the number of days since an injection.
References
1. Ostreicher M, Schwarz M. Relation between shoulder impingement syndrome and club head velocity in high-performance amateur golfers. Sportverletzung Sportschaden. 2013;27(2):108–111.
2. Townsend C, Von Rickenbach KJ, Bailowitz Z, Gellhorn AC. Post-Procedure Protocols Following Platelet-Rich Plasma Injections for Tendinopathy: A Systematic Review. PM&R. 2020;12(9):904–915.
3. Gremeaux V, Lamontagne M, Bélanger V, Dalmais E, Noël E, Frey A, Ornetti P, Allali F, Gross J, Michel F, Bard H, Kaux JF; GRIIP. Rehabilitation and return to activity after platelet-rich plasma injections in chronic tendinopathies: Consensus from international experts. PM&R. 2026;18(8):843–851.
4. Desmeules F, Roy JS, Lafrance S, Charron M, Dubé MO, Dupuis F, Beneciuk JM, Grimes J, Kim HM, Lamontagne M, McCreesh K, Shanley E, Vukobrat T, Michener LA. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy. 2025;55(4):235–274.
5. Puzzitiello RN, Patel BH, Nwachukwu BU, Allen AA, Forsythe B, Salzler MJ. Adverse Impact of Corticosteroid Injection on Rotator Cuff Tendon Health and Repair: A Systematic Review. Arthroscopy. 2020;36(5):1468–1475.
6. Kwong CA, Woodmass JM, Gusnowski EM, Bois AJ, Leblanc J, More KD, Lo IKY. Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial. Arthroscopy. 2021;37(2):510–517.
7. Demiral MF, Çankaya BY, Paksoy AE, Budak ES, Yalçın A, Uzkeser H, Kocaoğlu B. Addition of platelet-rich plasma to physiotherapy reduces tear volume and improves functional outcomes in articular-sided partial supraspinatus tendon tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2026;34(7):2535–2544.
8. Centeno CJ, Fausel Z, Dodson E, Berger DR, Steinmetz NJ. Percutaneous bone marrow concentrate and platelet products versus exercise therapy for the treatment of rotator cuff tears: a randomized controlled, crossover trial with 2-year follow-up. BMC Musculoskeletal Disorders. 2024;25(1):392.
9. Darrow M, Shaw B, Schmidt N, Boeger G, Budgett S. Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections. Cogent Medicine. 2019;6(1):1628883.