High-Volume Injections Fail Clinical Trial Test for Chronic Achilles Tendon Pain
Approximately 6% of people experience the condition during their lifetime. Although exercise-based rehabilitation is the recommended treatment, up to 44% of patients do not recover. Many consequently explore other options, including injections intended to reduce pain and improve tendon function.
Randomized Trial Compares Injections Against Placebo Procedures
Everyone also received the same exercise program, education, and guidance on modifying physical activity. Participants began the trial with an average score of 48.7, indicating substantial symptoms and functional limitations.
Short-Term Steroid Shifts Outweighed by One-Year Outcomes
At the one-year follow-up, researchers obtained results from 181 participants (94%). The two active injection approaches also showed no meaningful difference in their overall outcomes.
Injections without corticosteroid failed to outperform the placebo at any assessment point. Adding corticosteroid produced small improvements after six weeks, but these benefits were short-lived. However, the overall clinical results did not justify their routine use. No serious adverse events related to the trial treatments were reported.
Structural Tendon Degeneration and Rehabilitation Realities
Beyond the clinical trial findings, chronic tendon injuries often fail to behave like typical injuries. Physiophyx Physical Therapy notes that many chronic tendon injuries are not primarily inflammatory conditions, despite the traditional suffix in tendonitis. Instead, chronic tendons often show abnormal blood vessel growth and structural degeneration under a microscope, indicating that the tissue is struggling to repair itself rather than simply experiencing acute inflammation.
While rest may temporarily decrease symptoms, tendons require appropriate mechanical loading to remain healthy. Too much stress causes breakdown, while too little stress weakens the tissue further, explaining why pain frequently returns when patients resume activity. Strategies that encourage tendon adaptation, such as progressive strengthening, proper joint mobility, and shockwave therapy using acoustic pressure waves to stimulate biological healing responses and improve nutrient delivery, are often combined to address poorly vascularized tissues.
Clinical Reconsideration and Informed Patient Consent
The researchers acknowledged several limitations in the trial.
He emphasized that patients should never be told corticosteroid injections will fix or cure tendinopathy.
