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Small, uncontrolled study of prolotherapy and eccentric loading for tendinosis

PainSci » bibliography » Yelland et al 2011
Tags: tendinosis, treatment, exercise, injections, pain problems, overuse injury, injury, self-treatment, medicine

One article on PainSci cites Yelland 2011: Tissue Provocation Therapies

PainSci commentary on Yelland 2011: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is a trial of 40 patients, comparing eccentric loading exercises and prolotherapy, or a combination of the two. It looks like a win, and the evidence is worth noting, particularly about prolotherapy, but there are several caveats and the results must be taken with a grain of salt: it’s a small study with no control group, the short-term effect size is modest, and the long-term results were scarcely distinguishable. With a control group, for all we know, untreated individuals would have done just as well, or even better.

~ Paul Ingraham

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 compare the effectiveness and cost-effectiveness of eccentric loading exercises (ELE) with prolotherapy injections used singly and in combination for painful Achilles tendinosis.

DESIGN: A single-blinded randomised clinical trial. The primary outcome measure was the VISA-A questionnaire with a minimum clinically important change (MCIC) of 20 points.

SETTING: Five Australian primary care centres.

PARTICIPANTS: 43 patients with painful mid-portion Achilles tendinosis commenced and 40 completed treatment protocols.

INTERVENTIONS: Participants were randomised to a 12-week program of ELE (n=15), or prolotherapy injections of hypertonic glucose with lignocaine alongside the affected tendon (n=14) or combined treatment (n=14). Main outcome measurements VISA-A, pain, stiffness and limitation of activity scores; treatment costs.

RESULTS: At 12 months, proportions achieving the MCIC for VISA-A were 73\% for ELE, 79\% for prolotherapy and 86% for combined treatment. Mean (95% CI) increases in VISA-A scores at 12 months were 23.7 (15.6 to 31.9) for ELE, 27.5 (12.8 to 42.2) for prolotherapy and 41.1 (29.3 to 52.9) for combined treatment. At 6 weeks and 12 months, these increases were significantly less for ELE than for combined treatment. Compared with ELE, reductions in stiffness and limitation of activity occurred earlier with prolotherapy and reductions in pain, stiffness and limitation of activity occurred earlier with combined treatment. Combined treatment had the lowest incremental cost per additional responder ($A1539) compared with ELE.

CONCLUSIONS: For Achilles tendinosis, prolotherapy and particularly ELE combined with prolotherapy give more rapid improvements in symptoms than ELE alone but long-term VISA-A scores are similar.

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