Tendinopathy, a common condition characterized by pain and dysfunction in tendons, can significantly impact the quality of life for both athletes and non-athletes. This condition often results from overuse and leads to substantial limitations in daily activities and sports performance. Among the various treatment options, physical therapy with dry needling and corticosteroid injections have gained specific attention for their potential in providing pain relief. A recent systematic review published by Aman et al1Â explores the efficacy of these methods, aiming to inform healthcare providers and patients about their respective benefits and risks.
Understanding Tendinopathy
Tendinopathy represents a complex degenerative process within the tendon rather than just inflammation. Patients typically experience pain, stiffness, and decreased functionality, which can affect their quality of life. Common types of tendinopathy include Achilles tendinopathy, patellar tendinopathy, and lateral epicondylitis (tennis elbow). Common treatment approaches often involve rest and anti-inflammatory medications, but these typically do not achieve satisfactory results, prompting the exploration of alternatives such as dry needling and corticosteroid injections.
What is Dry Needling?
Dry needling is a technique used in physical therapy that involves inserting thin needles into trigger points or tight bands of muscle tissue. The primary goal is to relieve pain and improve function by eliciting a local twitch response, which can help relax the muscle and increase blood flow to the area. Practitioners, often physical therapists, believe that this technique can lead to biochemical changes that promote healing and offer effective pain relief.
What are Corticosteroid Injections?
Corticosteroid injections are anti-inflammatory medications injected directly into the tendon or surrounding tissue. They work by reducing inflammation and pain, providing temporary relief. While effective in the short term, there are concerns regarding their long-term safety, particularly the potential to weaken tendon tissue and increase the risk of rupture. This raises important considerations for patients seeking lasting pain relief.
The Study: Key Findings
The systematic review aimed to compare the effectiveness of dry needling and corticosteroid injections in treating tendinopathy. Researchers analyzed several studies, focusing on outcomes such as pain relief, functional improvement, and recovery times. Here are the key findings:
1. Effectiveness in Pain Reduction
Both dry needling and corticosteroid injections were effective in reducing pain associated with tendinopathy. However, the degree of pain relief varied among studies. Some patients reported significant improvements following dry needling, while others experienced more immediate relief with corticosteroid injections.
2. Functional Improvement
Functional outcomes, such as the ability to perform daily activities and sports, were also assessed. The review indicated that while corticosteroid injections might provide faster relief, dry needling could lead to more sustained functional improvements over time. This suggests that while corticosteroids might be a good option for quick pain relief, dry needling could offer longer-term benefits, making it an integral part of physical therapy.
3. Safety and Side Effects
One critical aspect of the review was the safety profile of both treatments. Corticosteroid injections, while effective, come with potential side effects, including tendon weakening and possible rupture, especially with repeated use. Dry needling, on the other hand, was generally well-tolerated, with minimal side effects primarily limited to temporary soreness at the needle insertion site.
4. Patient Preferences
Patient preference plays a vital role in treatment selection. Some patients prefer the quick relief provided by corticosteroid injections, while others may opt for dry needling due to concerns about side effects. The review highlighted the importance of involving patients in treatment decisions, considering their personal experiences and preferences.
Clinical Implications
The findings of this systematic review have significant implications for clinicians treating tendinopathy. Here are some considerations for healthcare providers:
1. Tailored Treatment Plans: Given the varying efficacy and safety profiles of the two treatments, healthcare providers should consider individual patient needs and preferences when designing treatment plans.
2. Educating Patients: Clinicians should educate patients about the potential benefits and risks associated with both dry needling and corticosteroid injections, empowering them to make informed decisions about their treatment options.
3. Combination Approaches: In some cases, a combination of treatments may be most effective. For instance, a patient might receive a corticosteroid injection for rapid pain relief followed by dry needling as part of their ongoing physical therapy for longer-term improvement.
Conclusion
Tendinopathy remains a challenging condition to treat, with various options available to manage pain and improve function. The systematic review comparing dry needling and corticosteroid injections offers valuable insights into the effectiveness, safety, and patient preferences associated with each treatment. While corticosteroid injections may provide quick pain relief, dry needling appears to offer longer-term benefits with fewer side effects, making it a vital component of a physical therapy plan of care.
If you have been diagnosed with tendinopathy or tendonitis and want to get back on track, book an appointment with one of our expert Denver Physical Therapists to devise a customized treatment approach for pain relief and return to activity.
Aman, Ifra MPT; Zutshi, Kalpana MPT; Singla, Depika MPT, PhD. Dry needling versus corticosteroid injections to treat tendinopathy: a systematic review. Journal of the International Society of Physical and Rehabilitation Medicine 6(3):p 77-82, September 2023. | DOI: 10.1097/ph9.0000000000000014