Tendinopathy Treatment Tactics

Chronic tendinopathy is probably the primary reason patients come to see me as a

musculoskeletal specialist. Tendinopathy (the injury of a tendon that attaches muscle to bone)

results either from acute injuries, such as tearing or straining a muscle, or overuse (slowly

developed injuries occurring from too much activity over a prolonged period of time).

Often when this happens, the hope is that conservative therapy (professional physical therapy paired with home exercise, relative rest, bracing, taping, etc.) will do the trick. However, there is a transition point where we progress into chronic injury, and physical changes takes place within a tendon. At that point, sometimes conservative therapy won’t work, and we have to broaden the tools we are using in order to provoke healing.

There are multiple tools that can help convert an older injury into something the body can heal;

two of which I’ll talk about in this blog post. The first is a type of injection called prolotherapy.

Prolotherapy, which is short for “proliferation therapy”, involves making a solution composed of concentrated dextrose (sugar solution).

Once the dextrose is at a certain concentration, it is diluted with lidocaine and injected into soft tissue (tendon, ligament, or bone). This can promote regeneration (“proliferation”) of healthy tissue.

Prolotherapy works very well for chronic tendinitis such as patellar tendinitis, golfer’s elbow, tennis elbow, and hamstring strain. It is also effective in treating ligament injuries (commonly known as “sprains”), and osteoarthritis of the knee, hip, or shoulder. We provide this treatment for all of the aforementioned injuries at SPARCC. Usually treatment involves at least three rounds of injections every 2-6 weeks. Though sometimes it may require less. This is, of course, dependent on how the patient responds to treatment.

The other type of injection provided by SPARCC that I would like to talk about is platelet-rich

plasma (PRP). This injection requires drawing the patient’s blood (yes, another needle!) and

putting it in a centrifuge. A centrifuge is a machine that spins the blood so fast it separates the

layers of red blood cells, white blood cells, and platelets.

The platelet-rich plasma contains a high concentration of growth factors. These growth factors stimulate healing in soft tissues like ligaments, tendons, muscles, and the joints themselves. The platelet-rich layer is then put into a syringe, and injected into the injured area. This type of injection works exceptionally well for osteoarthritis, as well as for healing acute and chronic injuries of the tendons and ligaments. Both of these injections yield very few side-effects because their solutions are fundamentally benign. One consists of numbing medicine and sugar while the other contains the patient’s own cells. Both treatments are relatively new. And even though we know they work well from studies and experience, it’s hard to say exactly how many injections a patient will need.

The length of efficacy for these treatments can also vary. From my experience, it usually takes 2-3

prolotherapy injections for observable benefit to occur. Positive effects can last for quite some

time, if not permanently. Though characteristically, if a patient continues to injure themselves

through overuse, and they don’t change their pattern of exercise or therapy, the long-term

benefits of PRP may be reduced. My patients who receive PRP and alter their

lifestyle usually only need one or two treatments per year. This all comes back to the old adage,

“Doc it hurts when I do this.” The doctor replies, “Then don’t do that.”

Inline skating is a surprisingly low-impact activity. After multiple sprained ankles caused by running, I decided to give it a try! It's now one of my greatest loves. An injury may be on opportunity to try something new. Wear your pads though! - Your friendly neighborhood SPARCC editor

I’d love to meet and talk with you about some of the discussed potential solutions for chronic

musculoskeletal pain. We can discuss any other potential methods of treatment as well. Feel

free to schedule an appointment with me. Let’s figure it out!

-Dr. Dill

Please note that this blog post does not serve as medical advice nor substitute for a proper evaluation with a licensed medical provider