Injecting your own blood doesn’t help tendinitis
One article on PainSci cites Bell 2013: Does Platelet-Rich Plasma Injection Work?
PainSci notes on Bell 2013:
Utterly unsurprising: injecting your own blood doesn’t help tendinitis. Nice to have a decent trial about this over-hyped therapy though: “The administration of two unguided peritendinous autologous blood injections one month apart, in addition to a standardised eccentric training programme, provides no additional benefit in the treatment of mid-portion Achilles tendinopathy.”
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVE: To assess the effectiveness of two peritendinous autologous blood injections in addition to a standardised eccentric calf strengthening programme in improving pain and function in patients with mid-portion Achilles tendinopathy.
DESIGN: Single centre, participant and single assessor blinded, parallel group, randomised, controlled trial.
SETTING: Single sports medicine clinic in New Zealand.
PARTICIPANTS: 53 adults (mean age 49, 53% men) with symptoms of unilateral mid-portion Achilles tendinopathy for at least three months. Participants were excluded if they had a history of previous Achilles tendon rupture or surgery or had undergone previous adjuvant treatments such as injectable therapies, glyceryl trinitrate patches, or extracorporeal shockwave therapy.
INTERVENTIONS: All participants underwent two unguided peritendinous injections one month apart with a standardised protocol. The treatment group had 3 mL of their own whole blood injected while the control group had no substance injected (needling only). Participants in both groups carried out a standardised and monitored 12 week eccentric calf training programme. Follow-up was at one, two, three and six months.
MAIN OUTCOME MEASURES: The primary outcome measure was the change in symptoms and function from baseline to six months with the Victorian Institute of Sport Assessment-Achilles (VISA-A) score. Secondary outcomes were the participant's perceived rehabilitation and their ability to return to sport.
RESULTS: 26 participants were randomly assigned to the treatment group and 27 to the control group. In total, 50 (94%) completed the six month study, with 25 in each group. Clear and clinically worthwhile improvements in the VISA-A score were evident at six months in both the treatment (change in score 18.7, 95% confidence interval 12.3 to 25.1) and control (19.9, 13.6 to 26.2) groups. The overall effect of treatment was not significant (P=0.689) and the 95% confidence intervals at all points precluded clinically meaningful benefit or harm. There was no significant difference between groups in secondary outcomes or in the levels of compliance with the eccentric calf strengthening programme. No adverse events were reported.
CONCLUSION: The administration of two unguided peritendinous autologous blood injections one month apart, in addition to a standardised eccentric training programme, provides no additional benefit in the treatment of mid-portion Achilles tendinopathy.
related content
- “Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review,” Robert-Jan de Vos, Johann Windt, and Adam Weir, British Journal of Sports Medicine, 2014.
- “Platelet-rich therapies for musculoskeletal soft tissue injuries,” Vinícius Y Moraes, Mário Lenza, Marcel Jun Tamaoki, Flávio Faloppa, and João Carlos Belloti, Cochrane Database of Systematic Reviews, 2014.
- “Autologous growth factor injections in chronic tendinopathy,” Michelle A Sandrey, Journal of Athletic Training, 2014.
- “Popular Blood Therapy May Not Work,” Gina Kolata, New York Times.
- “Meta-analysis Comparing Platelet-Rich Plasma vs Hyaluronic Acid Injection in Patients with Knee Osteoarthritis,” Yanhong Han, Hetao Huang, Jianke Pan, Jiongtong Lin, Lingfeng Zeng, Guihong Liang, Weiyi Yang, and Jun Liu, Pain Med, 2019.
- “The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment,” Xiao Chen, Ian A Jones, Caron Park, and Jr Vangsness, American Journal of Sports Medicine, 2018.
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- The CANBACK trial: a randomised, controlled clinical trial of oral cannabidiol for people presenting to the emergency department with acute low back pain. Bebee 2021 Med J Aust.
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- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.
- Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness. Nakale 2018 Foot Ankle Int.
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.