For patients presenting to their physician’s office with persistent tendon pain, a chronic strain can usually be to blame for the patient’s discomfort.
“When tendons are overloaded, whether through repetitive or a sudden increase in activity, it causes the tendon to weaken and makes it more susceptible to injury and the development of pain,” says Troy Henning, DO, assistant professor of physical medicine and rehabilitation.
Henning, colleague Daniel Lueders, MD, assistant professor of physical medicine and rehabilitation, and primary care sports medicine colleagues offer patients both nonsurgical and minimally invasive treatment options for treating their tendinopathy. One promising nonsurgical therapy is the use of platelet-rich plasma (PRP) injections, where a portion of the patient’s blood that has a high concentration of platelets is used to inject back into the diseased portion of the tendon.
“Traditional approaches have most often involved anti-inflammatory therapies, such as an injection of cortisone, but there is growing evidence that these injuries don’t involve as much inflammation as had once been thought, and such an approach may be unhelpful for healing and counterproductive as steroids can further weaken tendons,” Lueders says.
Interest in PRP has grown because of the potential for platelets to stimulate and accelerate tissue healing. As the platelets are injected and exposed to collagen in the tendon, they slowly activate and release growth factors and proteins.
“These factors lead to tissue regeneration through stimulation of angiogenesis, extracellular matrix production and collagen synthesis,” Henning says. “In theory, this normalizes the structural make of the tendon tissue.”
Lueders says the benefits of PRP are still being examined and may vary at different tendon sites. Although there is increasing evidence that PRP is effective in tennis elbow, which is one of the most common tendinopathies, the value of PRP for accelerating tissue repair at other sites, such as the Achilles tendon, plantar fascia and rotator cuff, is the subject of investigation and ongoing research.
Although there is much that is still unknown about PRP, the new therapy option showcases the understanding U-M musculoskeletal specialists have of the underlying molecular processes of healing.
“One of the advantages of our team is that we are taking an objective approach to understanding where PRP fits with other treatment options,” Lueders says.
PRP might not be the answer for every patient with a tendon injury, he cautions, and studies are still underway to establish optimal dosing and timing. However, it is an example of an innovative option available for individualizing care.
“We know structured rehabilitation has the best evidence for therapeutic benefit in patients with tendinopathies, but full recovery can be slow or incomplete,” Lueders explains. “Platelet-rich plasma affords us a safe and effective addition to our options for treating challenging tendon injuries. Our team has expertise in a broad array of treatments, which allows us to individualize therapy appropriately.”
U-M musculoskeletal specialists use a variety of treatments for tendinopathies:
“Most of the time, it just takes some focused exercises directed at the injured tendon to help restore its normal health and function,” Henning says. “In general, 80 percent of patients will respond to an exercise intervention alone.”
“We prescribe nitroglycerin patches to patients who seem to be having moderate to severe pain that is interfering with their ability to use the tendon,” Henning says. “The patch helps to normalize the function of the tendon cells. This, in turn, helps to reduce pain and may help heal the tendon.”
Minimally invasive procedures