Dr. John A. Lyftogt, Director and Clinical Scientist of Prolomed Limited in Christchurch, New Zealand, Published a Study on the Use of Prolotherapy Injections and Eccentric Loading Exercises for Painful Achilles Tendinosis in the British Journal of Sports Medicine
Dr. John A. Lyftogt, Director and Clinical Scientist of Prolomed Limited in Christchurch, New Zealand, published an article titled Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randonised trial in the British Journal of Sports Medicine; a single-blinded randomized clinical trial that aimed to compare the effectiveness of eccentric loading exercises (ELE) with prolotherapy injections used singly and in combination for the treatment of painful Achilles tendinosis.
Forty adults who had experienced painful unilateral or bilateral mid-portion Achilles tendinosis for at least 6 weeks were randomized into three twelve-week treatment protocols; ELE, prolotherapy injections, or a combination of both interventions. Patients who had undergone previous steroid or prolotherapy injections or surgery on the affected tendon, or had already completed >50% of the Achilles ELE protocol were excluded from the study. Participants assigned to the ELE group were instructed by a doctor or podiatrist to perform the protocol as described by Alfredson et al, adding weights as the pain eased over time. In the prolotherapy group, tender spots in the subcutaneous tissues adjacent to the affected tendon were injected with a solution consisting of 20% glucose/0.1% ropivocaine weekly for 4 to 12 treatments, using the technique as described by Lyftogt. The number of treatments was determined by the time it took to reach a pain-free activity state, or treatments were halted upon patient request.
The VISA-A was used as the study’s primary outcome measure, and was administered at baseline, 6 weeks, and at 3, 6 and 12 months. An increase of 20 points or more on the scale was considered a “treatment success”.
There were statistically significant improvements in VISA-A scores at each check point for all intervention groups, however, the most notable improvements were seen in the combined intervention group. Additionally, when compared with ELE, reductions in stiffness and limitation of activity occurred earlier with prolotherapy. Reductions in pain, stiffness, and limitation of activity occurred even earlier within the combined treatment group. Overall, the combined intervention appeared to provide more rapid improvements in symptoms as compared to the ELE or prolotherapy alone, however, in the long term, VISA-A scores were not significantly different amongst the three intervention groups.
While ELE offers a low cost self-managed program, it required considerable effort on the part of the patient. Prolotherapy is a relatively simple office treatment which is shown to be efficient and effective in reducing symptoms of pain and stiffness, however, it is more costly and involves the pain of multiple injections. The combination of the two approaches, though requiring the most effort on the patient’s part, is shown to yield the fastest results. Similar findings have been reported in other studies comparing single and combined treatments. This trial provides valuable information for future treatment trials of Achilles tendinosis.
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Article link: http://bjsm.bmj.com/content/45/5/421.long