Laurie's Blogs.

Going through a list of recent journal articles, the following caught my eye.

Giorgi E, Smith S, Drescher MJ, Rivera MJ. The Effectiveness of Dry Needling Combined With Therapeutic Exercises in Treating Tendinopathy Conditions: A Systematic Review. J Sport Rehabil. 2022 May 4;31(7):918-924. 

Unfortunately, I wasn’t able to get the whole paper, but just from the abstract the gist of it was that three reviewers looked at 7 studies that met their inclusion criterion.  They were looking for studies that used Dry Needling (DN) in combination with therapeutic exercise, had human participants, and active tendinopathy pathology.

They reported, “Current evidence supports the use of DN combined with therapeutic exercises, especially those including eccentric exercises, can improve pain and function for various tendinopathies. However, limited evidence exists regarding specific therapeutic interventions to be combined with DN.”

They concluded that there was moderate level B evidence to suggest benefit for combining these two therapies for tendinopathies. 

Okay, so then I went down the rabbit hole to discover what the ‘Similar Articles’ that pubmed was showing me had to say.

Irby et al 2020 conducted a systematic review of 25 systematic reviews!  They found the following:

“Eccentric exercises were the most common and consistently effective treatment for tendinopathy across systematic reviews. Low-level laser therapy and extracorporeal shockwave therapy demonstrated moderate effectiveness, while platelet-rich plasma injections demonstrated inconclusive evidence on their ability to decrease tendinopathy-related pain and improve function. Corticosteroids also showed some effectiveness for short-term pain, but for the long-term use deemed ineffective and at times contraindicated. Regarding surgical options, minimally invasive procedures were more effective compared to open surgical interventions. When treating tendinopathy regardless of location, eccentric exercises were the best treatment option to improve tendinopathy-related pain and improve self-reported function.”

A different review (Jayaseelan et al 2021) looked at just dry needling for the management of tendinopathy (screening 462 papers, and choosing 10 that met inclusion requirements).  They determined that DN may be a useful adjunctive treatment in the conservative management of tendinopathy, although its discrete effect is unclear. Very Low-quality evidence and methodological limitations suggest further investigation is warranted.

What do I take away from reading all of these abstracts / papers?  

Well, how fantastic that there are enough papers out there to actually DO systematic reviews on individual treatment techniques.  However, CLINICALLY, I would hope that your treatment plan is multimodal.  And to me, that means multimodal within your physiotherapy / rehabilitation plan.  I would do laser, shockwave, and eccentric exercises.  These studies suggest that you could ADD dry needling to your regimen (as an adjunct, but maybe not as a ‘stand-alone’ treatment).  Then going back through some of my previous blogs and presentations, there are other things to try as well – isometric exercises, manual trigger point releases to the MUSCLES attached to the affected tendon.  A small body of evidence shows that PEMF might be useful too!

All in all, I guess I just look at this and say ,‘Combine your therapies for maximum effect.’

That’s it for today!

Until next time,

Cheers!  

References:

Irby A, Gutierrez J, Chamberlin C, Thomas SJ, Rosen AB. Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments. Scand J Med Sci Sports. 2020 Oct;30(10):1810-1826. 

Jayaseelan DJ, T Faller B, H Avery M. The utilization and effects of filiform dry needling in the management of tendinopathy: a systematic review. Physiother Theory Pract. 2021 Apr 27:1-13.