Photo Credit: Scott, A. CMAJ. 2011. Mead, M. Transl Sports Med. 2018.
Tendon injuries have previously been diagnosed as tendonitis and were believed to be marked by an inflammatory process in the tissue. Our current knowledge on these injuries has been improved by a better understanding of the disease process behind tendon pain. Current research indicates tendon pain (tendinopathies) is caused by an ingrowth of nerve and blood vessels to the injured area of the tendon leading to increased sensitivity with loading. Further, as our body begins to heal the injured area of the tissue, tendon cells become more disorganized in nature. Conversely, healthy tendons display high degrees of organization with tendon fibers aligned in parallel along the lines of healthy stress. Gradual loading of the tendon through exercise promotes remodeling of the injured tissue. In short, both under and over loading tendons lengthens the recovery process.
A summary article on the available evidence behind tendon treatments was published in a sports medicine journal recently (Mead, M et al. Transl Sports Med. 2018). The authors reported on a general trend against the use of injections for tendon pain. This includes corticosteroid injections which may provide short term relief, but at the risk of further tendon injury or rupture. Further, the research does not support the use of injections including prolotherapy or PRP at this time. Conversely, the authors reported Physical Therapy including the use of loaded exercises, including eccentric exercise, should be considered a first line treatment for tendon pain and injury.
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