I enjoy treating tendon issues. Tendon pain is probably the most common musculoskeletal ailment, yet tendons are actually poorly understood. I like to think I have a bit of a specialty in tendon pain, having a video explaining tendon compression featured by the British Journal of Sports Medicine, teaching continuing education courses to other healthcare providers on how to diagnose and treat tendon pain as well as being asked by the Virginia Chiropractic Association to do a presentation on running and tendon pain at their Annual Conference last year. For reasons unknown to me, I enjoy learning about tendons.
So, I was very interested to read a systematic review (a study that compiles the results from all the best clinical trials on any particular topic) last week on surgery for tendon pain.
I will keep the summary very brief:
- 12 Randomized trails were included in the review: 7 on the shoulder (rotator cuff), 3 on the lateral elbow (tennis elbow), 1 on the patellar tendon and one on the Achilles tendon.
- They looked at results up to one year (midterm), and after one year (long term)
- Surgery was found to be superior to no treatment or placebo, but NOT superior to SHAM SURGERY for results up to one year or later.
- They recommend that surgery be reserved for select cases AND ONLY after an evidence based loading (rehabilitation) program (as outlined in my video) has been tried for at least 12 months.
TAKE HOME POINT: Unless it’s a full rupture of a tendon, reserve surgery for at least a year AFTER you have been undergoing a PROPER tendon rehabilitation protocol (A proper rehab protocol would NOT include things like EMS, laser, ultrasound, taping etc)