Tennis elbow, achilles tendonitis, rotator cuff tendonitis, IT Band syndrome, and hamstring tendonitis may be some conditions that you have experienced, or known a friend or family member to seek treatment for. These are common tendinopathies that physical therapists treat in the clinic. When patients arrive for their first treatment visit, they often have little understanding of what caused their condition or what their treatment options may be. To understand the benefit of different treatment options, it is first necessary to acquire a basic understanding of the pathology of tendinopathy.
A tendon is a fibrous structure that joins a muscle to a bone and transmits the force of the muscle contraction to the bone. When the tendon is injured, either by trauma or overuse of a muscle, tendonitis may develop. Tendonitis is inflammation, irritation, or swelling of a tendon that causes pain in and around the tendon. Tendonitis is often successfully treated with some combination of rest, prescribed anti-inflammatory medication, and physical therapy.
When tendonitis reoccurs over a long period of time, or overuse of a tendon is perpetuated, small tears occur in the tendon. This chronic, or long-term condition is called tendinosis. In this situation, the tendon has a reduced tensile strength, an increasing chance of rupture, and usually limits function due to pain and stiffness in the affected area.
Options for medical treatment of tendinosis traditionally include physical therapy, anti-inflammatory medication, corticosteroid injections, tenotomy, and surgery. More recently, PRP (platelet rich plasma) injections have become a more widely used treatment option, in part due to its successful use in treating the injuries of professional athletes. Although more research is needed regarding PRP’s effectiveness, many patients have reported positive outcomes following the treatment.
Physical therapy is one of the first lines of conservative treatment for chronic tendonitis or tendinosis. Patients are provided with an exercise program for restoring strength and soft tissue mobility that have been lost in and around the affected tendon. Modality and manual techniques are used for stimulating healing and improving tissue mobility. Often, the pain is resolved and strength and mobility are restored with physical therapy, in combination with prescribed medication and/or injections from the treating doctor. But what happens when these forms of conservative treatment are not enough?
The doctor may suggest surgery in this case, but an additional conservative treatment exists, and that is PRP. PRP is theorized to employ the body’s natural healing capacity to repair damage to the tendon structure. A small amount of the patient’s own blood is taken, spun in a centrifuge, making a concentrated mix of platelets and growth factors. The platelet rich plasma (PRP) is then injected into the damaged area of tendon, causing a mild inflammatory response, which re-starts the healing process. Because tendons have poor blood supply, they do not heal easily. The PRP injection is believed to stimulate healing in these areas of low blood supply.
What happens after your PRP injection? The factors that contributed to the development of the tendinopathy in the first place need to be addressed to help prevent recurrence.
Once cleared by your doctor, physical therapy may be prescribed following PRP treatment. Depending on the movement restrictions recommended by your doctor, the affected limb may be immobilized for a period of time following PRP treatment. When movement is allowed, physical therapy treatment may begin. The goal of physical therapy treatment following PRP is to restore the strength and mobility of the affected tendon and surrounding muscles.
Because the injected area is undergoing a renewed healing process, strengthening and movement exercises should be progressed gradually, with pain and swelling being carefully monitored and minimized throughout the process.
Physicians do not recommend anti-inflammatory medications in the weeks following PRP injection, as they may interfere with the intended healing process. If your doctor allows, swelling may be controlled with the application of ice packs to the affected area.
A time line for return to full daily, work, or sports activities will be primarily determined by your physician, with a physical therapy program designed to increase your activity tolerance and strength accordingly.
The ultimate goals of PRP treatment in combination with physical therapy are to restore the integrity of the damaged tendon and insure that the factors that caused the tendinopathy are resolved. If muscle weakness or reduced tissue flexibility/ mobility are not properly restored by an appropriate physical therapy program, the patient may experience re-injury, thus re-starting the process of tendonitis or tendinosis.
PRP in combination with physical therapy treatment for chronic tendinopathies may provide a more permanent solution for some patients who wish to avoid surgical intervention, but additional research in this area should be encouraged.
Many treatment options exist for treatment of chronic tendinopathies. Please discuss your options with your treating physician to determine the best course of care for you.
The following post was written by Leigh Anne Nash, PT, OCS of the Atlanta Falcons Physical Therapy Centers For more information about this team and their ten locations, visit www.atlantafalconsptc.com.