Volume 184 - Issue 4
The use of therapeutic medications for soft-tissue injuries in sports medicine
Authors: Justin A Paoloni and John W Orchard
Med J Aust 2006; 184 (4): 198-199. || doi: 10.5694/j.1326-5377.2006.tb00193.x
Published online: 20 February 2006
Published online: 20 February 2006
Justin A Paoloni,* John W Orchard†
* Conjoint Senior Lecturer, Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW. † Sports Physician, Sports Medicine at Sydney University, Sydney, NSW. pao_26AThotmail.com
In reply: We thank Masters and Yelland for their interest in this topic and their notification of additional references, some of which were published after our article was written.
We stated in our article that “the mechanism of any effect of corticosteroid injections in reducing symptoms in purely degenerative tendinopathies is unknown”, and that only where bursitis or tenosynovitis is present would the implication of an anti-inflammatory effect be appropriate.1 While blocking nociceptive C-fibres in normal tendon is demonstrated in the study quoted by Masters and Yelland,2 we still believe that corticosteroids should be used with caution for any tendinopathy where tendon weakening would be potentially harmful. We agree that corticosteroids have a much greater potential role in low back pain, which is a broad entity involving both soft-tissue and joint disorder.
At the time of writing our article there was a pilot study on polidocanol in painful tendons displaying neovascularisation;3 we thank the authors for advising that a randomised controlled trial has since been published.4 While undoubtedly an exciting new therapy, proponents of polidocanol do not consider its mechanism to be simply a “prolotherapy” effect; they also consider sclerosing the neovessels to be critical, and therefore, that hypertonic glucose (the most commonly recommended prolotherapy agent) may not work as well.
We still maintain that prolotherapy currently lacks evidence of efficacy for the treatment of soft-tissue injury in general, although it is relatively cheap and generally free of side effects. Both chronic low back pain, and chronic groin pain, are multifactorial conditions involving joint/bone abnormality which we considered slightly beyond the scope of an article on soft-tissue injuries. We await further publications on the efficacy of prolotherapy with interest.
References
- Paoloni JA, Orchard JW. The use of therapeutic medications for soft-tissue injuries in sports medicine. Med J Aust 2005; 183: 384-388. <eMJA full text>
- Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand 1990; 34: 335-338. 0_CBBBEEDC
- Alfredson H, Ohberg L. Neovascularisation in chronic painful patellar tendinosis — promising results after sclerosing neovessels outside the tendon challenge the need for surgery. Knee Surg Sports Traumatolo Arthrosc 2005; 13: 74-80. 0_i1091547
- Alfredson H, Ohberg L. Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2005; 13: 338-344. 0_i1091549