Have a futher look into the research here:
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.[1] 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:
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. Splints, Orthotics and Taping
Splints and orthotics can be used alongside other 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 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.[2] Take a look at the research below to inform your clinical reasoning.
Acupuncture is an area of controversy as randomised controlled blinded studies can be nearly impossible to elicit as patient who undergo a placebo acupuncture with placebo needles or other method which include applying pressure to the acupuncture spot can elict a similar response as an acupuncture needle through acupresure, an important point to consider when resding the methodology. Acupuncture has been show effective in treating the pain in patients with tendinopathy both acute and chronic. So possibly a worth while adjunct to our rehabilitation. Here is some of the research which may help you in your clinical reasoning.
A skill in which is used throughout physiotherapy, whether it is mobilising a joint, mobilising soft tissue, deep transver friction massage or general soft tissue massage. Clinically reasoned throughout our treatments but does it apply to tendinopathy? Evidence has suggested that manual therapy may help to decrease pain from souces of which are potentially biased and other research suggests massage has no greater effect of symptoms than other treatment modalities. Many reviews have been conducted to look at the effectiveness of hands on treatments:
Dry needling is another potential treatment for Tendinopathy. A combined therapy of dry needling with percutaneous hydrostatic decompression yielded promising outcomes in terms of pain and function. However,in a recent cohort study, a high-volume image-guided injection (HVIGI) without dry needling compared with a lower volume of HVIGI with dry needling resulted in greater improvement in managing Tendinopathy[3] Current reasearch suggests that inital short term does of NSAIDs may help with pain relief and assist with the compliance of physiotherapy but have no longer term affects on tendinopathy. NSAIDs are a topic for discussion when it comes to tendinopathies, as in the title of nonsteroidal ANTI-INFLAMMATORY drug, when the whole discussion of inflammation within tendinopathy is debatable. If it helps in the short term with pain, is this debate and discussion necessary or just something to be aware of? Have a further read in some of the journals below and see what you think.
High concentrations of platelets and growth factors in platelet-enriched plasma (PRP) injections is believed to promote tendon repair and inhibit pain.[4] PRP is made by extracting blood from the patient, centrifuging the sample and separating it into components to return platelets to the donor’s effected tendon. Evidence is patchy however some success has been reported in the treatment of patella tendiopathy, lateral epicondylitis and plantar fasciopathy. PRP therapy is also being used to treat acute muscle injuries with ongoing research underway [5][6] Although currently there is limited evidence to support BFRT in the upper limb, there are a number of case studies being published that have seen positive results in treating upper limb tendinopathy.[7] BFRT is also known as tissue flossing. BFRT, or tissue flossing, involves applying an external pressure above or below a muscle or joint of the extremities, typically by using a circumferential, elastic band. The pressure provided by the coiled band safely maintains arterial inflow of blood but reduces or occludes venous outflow distal to the site. Read more about BFRT here.
Acupuncture
Manual Therapy and Massage
Dry Needling
Nonsteroidal anti-inflammatory drug NSAIDs
Platelet-enriched Plasma (PRP) injection therapy
Blood Flow Restriction Training (BFRT) therapy
References