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Get to the Point – Injection Therapies

Tendinopathies are not uncommon and are often a consequence of overuse or degeneration/wear and tear. Tendinopathy pain can interfere with everyday life depending on what tendon is involved, and so a lot of research has been done to look at what is special about different tendinopathies and how they are most effectively treated.

A huge range of options for tendinopathy treatment are given to patients, but what do we really know about how effective they are and how they work?

Steroid Injections

This kind of anti inflammatory injection is the mainstay of injection treatments for tendinopathy, despite the fact that most tendinopathies have no inflammation. Weird huh?  They are not sure why this is but early on the injection may help with exercise and manual treatment because it reduces pain in the area – but given there is no inflammation to actually affect, there is a possibility that injection therapy has more of a placebo effect in the longer term and is not as effective as other options.  Steroid injections, if delivered inside the tendon, can actually weaken the tendon for several weeks, which is when people are most likely to be getting treatment and exercise.

Steriods can be more effective in bursitis and tendonitis, where inflammation is a key part of the condition. For example, some tendonitis in the hands can be virtually cured in over 80% of people.  However, 9% of tendinopathy recipients can develop tendon atrophy – that means instead of getting better, it gets worse.

Platelet Rich Plasma Injections

Platelet Rich Plasma (PRP) injections are relatively new. The platelets within the injection are rich in tissue repair protein simulators.  The idea behind these injections is that they will promote tendon tissue growth if injected into a broken down tendon but there has not been enough done to know how large an injection is best, how many would be needed, or if there is a dose dependent response (ie the more you deliver, the more repair, so you might deliver more to a more damaged tendon).  There just isn’t the evidence yet.

Hyaluraonic Acid Injections

Hyaluronic injections have been shown to help with osteoarthritis.  The idea behind these injections is that they would help with “gliding and sliding” for a tendon much in the same way they help with osteoarthritic joints.  These injections are still being studied.

Other injections

There are other injection types – injecting irritants to stimulate blood flow for example. We know that healthy tendons are not supposed to have high blood flow – and those which are painful have higher blood flow.  It’s still unknown if this kind of injection type will actually help (though in other tissues more perfusion is generally a good thing!)  These are all classic examples of how ‘it should make sense’ hasn’t actually proven itself out in reality.

If you’re unsure of injection therapies, why not try osteopathy?  Exercise, manual therapy and other guidance does help people with tendinopathy pain.


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