High volume injections do not appear to be effective in the treatment for mid-portion Achilles tendinopathy

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There are a range of therapies that have been suggested as possible treatments for the treatment of Achilles tendinopathy. This edition of the FastFact highlights a paper, published in the BMJ, that evaluates the effectiveness of high volume injections.1

High volume injections involve injecting a large amount of fluid into the area surrounding a painful tendon. The aim of this type of procedure is to obliterate peri-tendinous and intra-tendinous neovascularisation (using mechanical pressure) and in doing so improve a patient’s symptoms. There is some limited evidence that these injection can be effective. These papers have small sample sizes, involve the injection of corticosteroids (along with saline) and a range of other methodological concerns. The effectiveness has not been tested in large well designed studies.

In this patient- and assessor-blinded, placebo controlled, randomised clinical trial a total of 80 adults (aged 18-70 years) who had been diagnosed with mid-portion Achilles tendinopathy and who had neovascularisation on ultrasound were recruited. A total of 39 were randomised to a high volume injection (without corticosteroids) and 41 to the placebo arm. All of the study participants underwent an exercise programme for 24 weeks. Those in the intervention group had a single 50 mL high volume injection of saline and lidocaine while those in the control group had a single 2 mL injection of saline and lidocaine. The primary outcome measure was the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. There were a range of secondary outcome measures including patient satisfaction, ability to return to sport, ultrasound appearance and a range of functional measures. Participants were evaluated at baseline and at 2, 6, 12, and 24 weeks.

Over the course of the study there was a clinically significant improvement in the VISA-A scores in both groups. There was no statistically significant difference between the groups in either the VISA-A scale or the other outcomes measures. It should be noted that patient satisfaction was relatively poor with approximately 50% of participants in each group reporting a good or excellent outcome (57% in the intervention group and 49% in the control group). Less than 20% of the patients in each group were able to return to their pre-injury level of sport.

This is a well designed and implemented clinical trial. Based on the results of this study it would appear that high volume injections are not an effective treatment for Achilles tendinopathy. It is important to highlight that the results may not be generalisable to younger, elite football players. The relatively short follow-up period is also worth highlighting.

To learn more about the treatment options for tendon conditions consider completing the ‘Tendon module’ in the FIFA Diploma in Football Medicine.

Reference
1. van der Vlist Arco C, van Oosterom Robert F, van Veldhoven Peter L J, Bierma-Zeinstra Sita M A, Waarsing Jan H, Verhaar Jan A N et al. Effectiveness of a high volume injection as treatment for chronic Achilles tendinopathy: randomised controlled trial BMJ 2020; 370 :m3027

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Zeke
18 September 2020 21:43

Connective tissue cells between tendon fiber are damaged and they are inflame building up urea in area creating swelling and pain. Cell body is not in normal shape and are not able to produce amino acid necessary to take way urea in normal cell syntheses. My research show, if we topically feeding effected area true skin pores with Elixir reach with D type amino acids we can eliminate swelling and pain in just few two hours treatment. After treatments you need about two weeks, plus, exercise to bring muscles bake to normal and you are ready to go like before.… Read more »

Todd Watson
24 September 2020 20:47
Reply to  Zeke

Zeke,
Where do you obtain your Elixir with D type amino acids?

Zeke
18 September 2020 22:32

I spend about eight years researching and developing Elixir to reduce swelling. I have rehabilitation center were we use only Elixir, and proper exercise, and we are able to have sportiest returnee to normal activities much quicker.

Bangoura
Bangoura
23 September 2020 13:27

LE TENDON D ACHILLE EST LIE AU MUSCLE DU MOLLET ET A L OS DU TALON LES TENDINOPATHIES SONT FREQUENTES CHEZ LES PERSONNES PRATIQUANT LES ACTIVITES PHYSIQUES ET SPORTIVES ELLES PEUVENT ATTAQUEES AUSSI DES PERSONNES INVALIDES. L ECHOGRAPHIE SEMBLE L IMAGERIE LA PLUS FIABLE. EN DIAGNOSTIQUE DIFFERENCIEL NOUS AVONS DIFFERENTS TYPES DE LESIONS LES TENDINITES SANS LESIONS LES RUPTURES PARTIELLES ET TOTALES LES DECHIRURES. LES TENDINITES SONT D ORIGINE MECANIQUE ET DEGENERATIVE. LE TENDON EST PEUT VASCULARISE MAIS BIEN INERVE. SUR LE PLAN MEDICAL IMMOBILISATION DU PIED POUR NE PAS FAIRE TRAVAILLER LE TENDON. GLACE ANTALGIQUE AINS TRAVAIL EXCENTRIQUE ETTIREMENT… Read more »

HR!MR11qq
25 September 2020 12:08

Leatherhead Football Club Guildford Road Leatherhead Surrey KT22 9AS 01372 360151 http://www.leatherheadfc.com Due to the ongoing infrastructural development going on Leatherhead Football Club, We want to use this medium to inform you that vacancies is now on Leatherhead Football Club UK. vacancies list: Medical Staff Pharmacies Medical Doctor Physiotherapist Fitness Trainer Secretary Manager Coaching Staff Physiotherapy Physical Therapist Clinical Operations Physical Therapy Technical Director Nurse do you have interest to work with our medical staff here in London UK, if yes you have interest kindly inbox me your c.v. resume We shall send you appointment letter (Benefit and Entitlement) if… Read more »