Andres, Brett and Murrell, George. Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon. Orthopaedic Research Institute, St George Hospital, University of New South Wales, Level 2 Research and Education Building, 4-10 South Street, Kogarah, Sydney, NSW, 2217, Australia, Published online: April 30, 2008.

Abstract: Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions. Thus, traditional treatment modalities aimed at controlling inflammation such as corticosteroids Prolotherapy injections and non-steroidal anti-inflammatory drugs (research paper at prolotherapy.org) may not be the most effective options. We performed a systematic review of the literature to determine the best treatment options for tendinopathy. We evaluated the effectiveness of NSAIDs, corticosteroid injections, exercise-based physical therapy, physical therapy modalities, shock wave therapy, sclerotherapy, nitric oxide patches, surgery, growth factors, and stem cell treatment. NSAIDS and corticosteroids appear to provide pain relief in the short term, but their effectiveness in the long term has not been demonstrated. We identified inconsistent results with shock wave therapy and physical therapy modalities such as ultrasound, iontophoresis and low-level laser therapy. Current data support the use of eccentric strengthening protocols, sclerotherapy, and nitric oxide patches, but larger, multicenter trials are needed to confirm the early results with these treatments. Preliminary work with growth factors and stem cells is promising, but further study is required in these fields. Surgery remains the last option due to the morbidity and inconsistent outcomes. The ideal treatment for tendinopathy remains unclear.
 

Caring Medical’s View:

This is a great article about the many traditional and alternative treatments available for the treatment of tendinopathy. As we at Caring Medical and Rehabilitation Services have known for many years, corticosteroids, NSAIDS, ultrasound, and shock wave therapy do not provide repair or strengthening of the underlying cause of many painful conditions which is weakened or stretched ligaments or tendons; nor do these treatments provide long term pain relief. We do know that ligaments and tendons have poor blood supply which inhibits much of the body’s own ability to heal such injuries to these structures. Exercise alone will help keep the joint moving and may help the overall blood flow to the ligaments and tendons, but in reality exercise only helps keep the muscles strong and the joint moving while the degenerative process of the joint still occurs. Sclerotherapy, also known as Prolotherapy, directly addresses not only the lack of blood flow to the ligaments and tendons, but also causes a localized inflammatory response to attract the immune system to repair the weak, stretched or torn ligaments and tendons through increased fibroblast activity. We have seen many patients through the years who have failed the previously mentioned therapies yet succeed after a few treatments of  Prolotherapy.

As for their preliminary work on growth factors and stem cells, we have been utilizing growth factors retrieved from a patients’ blood samples (see platelet rich plasma) for almost 2 years now and have seen great results in the repair of not only tendinopathy, but also of labral tears in both the shoulder and hip.