Steroid Treatment for Tendon Pain: Help or Hindrance in Rehab?

Steroid-Treatment-for-Tendon-Pain-Help-or-Hindrance-in-Rehab

Tendinopathy is a condition common to athletes but also experienced by non-athletic  patients. Tendinopathy is generally not associated with or preceded by trauma, but rather appears to develop gradually over time due to overburdening of a tendon.

When an athlete or other patient seeks traditional medical attention for tendon pain, the first line of treatment is often corticosteroid injections (CSI) to reduce inflammation and ease discomfort.

Oftentimes, steroid injections are given in conjunction with physical therapy, to help the patient withstand the discomforts associated with therapeutic exercises. However, new research suggests that CSI may actually interfere with physical therapy and delay rehabilitation.

Effect of Exercise on Tendon Structure

Overload is the principle by which muscle and tendon cells become stronger. The idea is to challenge the body’s structures by working them harder than they are accustomed to, in order to stimulate an adaptive response at the cellular level. Overload is the underlying principle of the maxim, “No pain, no gain.”

It has been demonstrated that slow eccentric (muscle lengthening) movements performed with heavy resistance have a positive effect on strengthening and repairing tendon tissue. Exercise stimulates the formation of new collagen and matrix proteins within the tendon, a process called mechanotransduction, meaning exercise has a positive effect on tendon structure.

CSI Effect on Tendon Tissue

Emerging research suggests that while CSI treatment has a positive short-term effect on pain reduction, CSI may interfere with and delay tendon recovery. It appears that local glucocorticoid injections may have a harmful effect on newly forming tendon cells, reducing their viability and proliferation, and delaying the synthesis of collagen.

In addition to inhibiting tendon repair in the short run, some clinical evidence reveals significantly harmful long-term effects of CSI on tendon tissue and new cells. In other words, while CSI helps reduce pain in the short run, it may do long-term and irreversible damage to tendon cells in the long run.

Studies on CSI and Tendinopathy Rehab

A growing body of research points to the potentially harmful effects of CSI on tendon rehabilitation:

  • Coombes et al. (2016) studied patients with lateral elbow tendiopathy and found that recovery outcomes were delayed and reduced in patients who had CSI treatment. The researchers concluded that CSI should not be regarded as a first-line treatment for tendinopathy.
  • In a review of studies on lateral hip pain, Lustenberger et al. (2011) noted that a significant number of patients who had multiple CSI treatments eventually ended up having surgery, although no direct correlation was implied. The research team found shock wave therapy to be an effective treatment for tendinopathy compared to CSI.

While evidence about the effect of CSI on tendon recovery is inconclusive, patients with tendinopathy, especially athletes whose careers hinge on recovery, should be wary of CSI as a first line of treatment.

Tendinopathy Treatment in NYC

The skilled sports medicine practitioners at NYDNRehab understand the importance of full recovery from tendinopathy for athletes and anyone who wants to maintain optimal physical function. We go beyond just treating pain, working with patients to get to the source of the problem.

If you are suffering from tendinopathy or other types of muscle pain, NYDNRehab can help. Our progressive clinic uses state-of-the-art technology to diagnose and treat musculoskeletal pain and dysfunction. Contact NYDNRehab today to get to the source of your pain, and get back to your active lifestyle.

 

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