Tendinopathy Treatment Adjuncts

 Introduction

On this page we are going to look at the different types of treatment in adjunct to exercises / rehabilitation . We will explain each method with a summary of each treatment and link to some more evidence for you to read.

Extracoropreal Shockwave Therapy (ESWT)

ESWT is a method which has conflicting evidence for and against the use. ESWT is when high energy acustic pressure waves are delivered to the affected area. This is done through a probe that touches the skin similar to an ultrasound head. The evidence for use is only recommended in certain chronic/degenerative tendons with the idea that this treatment can reverse the degerative process and take the tendon back into the acute stage to stimulate the healing process again. 

 There are a couple of drawback with this treatment, that the treatment itself can be painful but also the machine is very costly. 

Have a futher look into the research here: 

• A systematic review for shockwave therapies in soft tissue conditions: focusing on the evidence 
• Extracorporeal shockwave therapy for patella tendinopathy: A review of the litrature 
• ESWT in the management of patella tendinopathy 
• The effectiveness of extracorporeal shockwave therapy in lower limb tendinopathy: A systematic review 

Glyceryl Trintrate (GTN)

Tropical glyceryl trinitrate (GTN) has been used in the past to treat tendinopathy. The theory behind the use of GTN is that it stimulates healing within the tendon by increasing the amount of nitric oxide. It is said to induce the reaction of fibroblast proliferation, collegen synthesis and cotraction of collagen lattices. There is some conflict in the research with the use of GTN and as with all research; further research needs to be done to withdraw conclusion. But you can read some of the articles here: 

• Tropical glyceryl trinitrate treatment of chronic patella tendinopathy; A randomised, double blinded placebo-controlled clinical trial 
• 50 Recalcitrant Achilles Tendinopathy Treated With Exercise And Glyceryl Trinitrate: A Case Report
• Randomised, double-blind, placebo-controlled clinical trial of a new topical glyceryl trinitrate patch for chronic lateral epicondylosis

Ultrasound Electrotherapy

Ultrasound in a very common treatment modality. It is a non invasive procedure which involves sending soundwaves at different depths and rates into the tissue to atempt to have a physiological affect and aid in the healing process. There are many articles on the use of electrotherapy and ultrasound any of which not if favour. The BC Physical Therapy Tendinopathy Taskforce recently did an extensive litrature serach on the effectivness of treatments on tendinopathy, ultrasound was one of these modalities. They came to the conclusion that there was no evidence to support the use of ultrasound in the acute phase but this could be physiologically reasoned, but for the more chronic phase neither could be supported. Some of the research is here:

• Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon

Splints, Orthotics and Taping  

Splints and orthotics can be used alongside oter treatments for tendinopathy. There is research looking at foot orthosis, tennis elbow clasps and taping in tendinopathy. Research does not suggest that orthotics or taping alone will treat the poblem, they may assist in the management as an adjunct. For example a heel lift may off load an achilles tendinopathy for pain management, but the appropriate rehabilitation is still required which you can read about here. Some articles of interest are listed below:

• Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial
• Cost effectiveness of brace, physiotherapy, or both for treatment of tennis elbow
• Effects of taping on pain, grip strength and wrist extension force in patients with tennis elbow
• The efficacy of taping for the rotator cuss tendinopathy: A systematic review and meta-analysis

Injections 

Corticosteroid injections are a common treatment modality for tendinopathy, but do they work? Looking at the research different methodology is used therefore this makes studies hard to compare, leaving gaps in the research. More current research suggests that initially injections may be beneficial but in the intermediate and long term other treatments may be more beneficial. There has been a high incidence in reoccurance of symptoms after injection. So does it have it's place? Potentially when working with high level athletes if they have a competition or a game, but this still is not a full gone conclusion and is just based on clinical reasoning with all the risks of an invasive procedure and no long term benefits known, although is reccommended in British Medical Journal for many tendinopathies. Take a look at the research below to inform your clinical reasoning. 

• Corticosteroid Injections for Common Musculoskeletal Conditions
• The challenge of managing tendinopathy in competing athletes
• Corticosteroid and other injections in the management of tendinopathies: a review