Longer Term Use Of Cortico-steroids For Tendinopathies Worse Than No Treatment At All
GPs are being advised to only use short courses of steroid injections to treat tendinopathies, after a systematic review found using them for longer can produce worse results than no treatment.
Instead they are being advised to use other methods of non-steroidal injections for treatment such as botulinum toxin and hyaluronic acid for conditions such as tennis elbow and other tendinopathies.
The extensive review – published in The Lancet – looked at 41 trials involving 2,672 patients and estimated the standardised mean differences between treatments and placebo.
Steroid administration was shown to be consistently effective over the short term but long term the benefit was unclear. For further information the full article can be found here, and the actual paper is here. Read more
“There is a high risk of poor long-term outcomes and higher recurrence rates with corticosteroid injections,” said lead author Bill Vicenzino, chair of sports physiotherapy in the School of Health and Rehabilitation Sciences at the University of Queensland.
“Other treatments, including exercise, some specific physiotherapy and possibly some other injections, should be used before corticosteroid injections,” Vicenzino said.
A Role For Medical Acupuncture?
A critical review by L.Viola of the literature showed some evidence of increased effectiveness of medical acupuncture over steroid injection, however the study sample quoted was limited and further research is required with larger samples.
A study by Val Jones published in Shoulder and elbow concluded that Acupuncture is frequently used by Chiropractors, physiotherapists in the management of chronic tennis elbow . However, the very few acupuncture studies to date have failed to prove conclusively that the short term relief in pain seen gives rise to long term functional improvement. No trials to date have assessed, concentrated or commented on the potential adverse effects of this particular form of treatment. The most recentCochrane review concludes there is insufficient evidence to support or refute the use of acupuncture. Further trials utilizing appropriate methodology and adequate sample sizes are needed before firm conclusions can be drawn regarding this treatment modality.
So Can Acupuncture Help?
In my opinion which is based solely on anecdotal cases, there is definitely a role for medical acupuncture in relieving short-term pain over general soft-tissue therapy alone. However it is likely that the combination of supportive taping, clasps, acupuncture, ice and heat therapy plus mobilisation and manipulation is probably the best route of care. This is due to the stimulation of repair, control of inflammation and restoration of accurate controlling reflexes.
From a personal view point just today I have been self administering acupuncture for a strain on my very own Tennis elbow, now I have to be disciplined and not play tennis tonight, pity as I was just starting to perfect my top-spin forehand, (probably wasn’t perfected, hence the injury). Physician heal thyself!