As clinicians we all know how tricky tendon pathology can be to treat, especially the grumbly degenerative tendons which are prone to reactive flare ups from time to time (Cook, 2009). I am sure you are all familiar with the evidence for graded exercise in the management of tendinopathies, as well as soft tissue therapy and various offload techniques that can be applied.
There is also clinical evidence for triple therapy medication (ibuprofen, doxycycline and ECGC) to help settle the nasty reactive tendon. However despite best efforts, these tendons can prove stubborn and sometime resistant to conservative treatment.
We may get better results by incorporating acupuncture into the course of treatment? I would routinely needle any trigger points found in the calf muscles, but what about needling the tendon itself?