Injections are often offered in the management of tendinopathy when things are not going so well. The pain may simply not be settling, things may be dragging on, and exercise and other treatments just not hitting the mark. Unfortunately, patients do get to these cross roads and it can be frustrating. Some have a feeling that something has been missed, others just want to find that elusive ‘fix’.
The reality is that in many cases nothing has been missed, and there is no magic bullet – what is needed is patience and doing the basics very well – you can read all about the principles of managing tendinopathy in this blog post.
That is not to say that injections are not indicated. For some they are useful adjuncts. By definition an adjunct is something that can help, in some small or large way, in achieving the treatment goals but should not be the sole interventions – often less pain and more function for a tendinopathy patient.
So if you are considering an injection to treat a tendinopathy issue, this decision should obviously be made by you, in consultation with your health professional, and often the reasoning is complex and should be based around your individual presentation or case.
Knowing something about the evidence may also help to inform this decision. It is not the be all and end all, but worth considering
So which tendinopathy injections work and which ones do not, based on the scientific literature?
One of the most popular injections for tendinopathy is platelet rich plasma (PRP) or autologous blood injection (ABI). However, good quality randomised controlled trials have consistently show that there may not be any beneficial effects when compared to placebo (e.g. recent review by Tsirkopoulos 2015).
Although less popular, lots of other substances are injected into and around tendons, including prolotherapy and sclerosing agents like polidocinol. A recent systematic review appraised evidence for all injections in Achilles tendinopathy and concluded that there is no strong evidence supporting the use of any local pharmacological agent in treating Achilles tendinopathy. And the story is the same for all tendons.
The other common injection is steroid or cortisone or corticosteroid. This is a strong anti-inflammatory that is very useful for treating pain in the short term. HOWEVER, this study in tennis elbow actually showed people having steroid we worse in the long term even if they had exercise following the injection. Also, steroid is thought to be associated with a risk of tendon damage or rupture.
Overall, injections may work for some, especially if individualised to your presentation, but they are clearly do not provide that ‘quick fix’ for everyone.
