Anti-inflammatories and tendons

A few months ago I updated my guide to repetitive strain injuries with some nifty science showing that, contrary to a popular belief among professionals, chronically painful tendons are actually inflamed — not in the usual sense, with obvious immune system activity and redness and swelling, but in a subtler way (see Dakin et al). Inflammation is a complex family of tissue states, and at least some more obscure markers of inflammation are present in distressed tendons.

So if they are inflamed, do anti-inflammatory medications help? I’ve always thought it’s unlikely, either because there is no inflammation at all, or it’s too different from classic acute inflammation to be affected by drugs known for their effects on that condition. I wondered about this for ages and finally looked for relevant evidence. In another update last week, I reported on one rare and interesting example of useful research about it, a 2003 study that showed a measurable effect on a couple of obvious inflammation markers (see Marsolais et al). Unfortunately, and predictably, this effect “did not translate into a reduction of tissue damage or a promotion of tissue healing.” So while it attenuated some gross signs of inflammation, what little was present, it had no impact on the “mechanical properties” of injured Achilles tendons — and, I’m betting, probably not on the subtler signs of inflammation measured by Dakin and friends either.