Background
Tendinopathy is the term given to sick tendons - the structures which connect muscle to bone. Tendinopathy can occur in all regions of the body, including the achilles, knee, groin, shoulder, and elbow. Tendinopathies are painful, often limiting the ability to undertake work and participate in leisure activities, and can be slow to heal. Common treatments include exercise prescription, manual therapy, dry needling, corticosteroid injection, taping and bracing, load management, non-steroidal anti-inflammatory medication, education, and advice. One type of tendinopathy, on the outside of the elbow (lateral elbow tendinopathy), occurs in around 1 - 3% of the population. Those who work in manual occupations, tennis players and smokers are at an increased risk of developing this condition.
A few years ago, Dr. Alison Grimaldi, a physiotherapist, researcher and educator, wrote an interesting blog on the effects of corticosteroid injection in tendinopathy management. Highlighting the best available evidence, she discusses how corticosteroid injection does more harm than good to the recovery process of those with tendinopathies.
Highlights
Corticosteroid injection can be a tempting treatment for the often immediate pain relief it can give to those with tendinopathies. It is also commonly recommended early on by medical practitioners. However, serious consideration should be given to the ‘short-term gain, long-term pain’ outcomes associated with this treatment type.
Key take home points from the research are:
- Steroid injections provide no more benefit than placebo
- Corticosteroid injection is in fact harmful to tendon tissue and extends healing times
- Exercise is beneficial for tendon tissue and pain relief
- Conservative treatment modalities should be exhausted before considering an injection
Implications
Now you’ve been convinced that corticosteroids are bad for tendons, what alternatives does that leave for immediate pain relief? An empathetic interaction with a health professional may prove more beneficial for its pain-relieving effects. Enter, your Employ Health physiotherapist.
A recent study investigated the effect of empathetic patient-therapist interaction on pain relief. The randomised control-trial compared neutral versus empathetic interactions with an actor, playing a research assistant, on pain relief in people with lateral elbow tendinopathy. Both groups experienced a pain-relieving effect due to the interaction and unsurprisingly the group with the more empathetic interaction experienced this to a greater effect.
As occupational health physiotherapists, Employ Health are in the perfect position to provide empathetic education and advice to workers with tendinopathies, and their workplaces, to ensure the quickest road to recovery. In a workplace setting, practical examples often include reviewing how a worker is completing a certain aggravating task to see what improvements can be made, providing an exercise program and collaborating with the worker and workplace to advise on optimal load management.
References:
Cook, J. (2018). Ten treatments to avoid in patients with lower limb tendon pain. Br J Sports Med;52:884.
Coombes BK, Bisset L, Vicenzino B. (2015). Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. J Orthop Sports Phys Ther;45(11):938-949. doi:10.2519/jospt.2015.5841
Hamilton, P. (1986). The prevalence of humeral epicondylitis: a survey in general practice. J R Coll Gen Pract. 36: 464– 465.
Muhsen, Moss, Gibson, Walker, Jacques, Schug and Wright (2020). The Influence of a Positive Empathetic Interaction on Conditioned Pain Modulation and Manipulation Induced Analgesia in People with Lateral Epicondylalgia. Retrieved from: https://research-repository.uwa.edu.au/en/publications/the-influence-of-a-positive-empathetic-interaction-on-conditioned
Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. (2006). Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 164: 1065– 1074. http://dx.doi.org/10.1093/aje/kwj325
Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. (2004) Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum. 2004; 51: 642– 651. http://dx.doi.org/10.1002/art.20535
Moraes VY, Lenza M, Tamaoki MJ, et al. (2014). Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev 2014:CD010071.