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?
There is new evidence acupuncture may facilitate blood flow (a CGRP response) and assist tendon healing with a single needle placed within the paratenon between sheath and tendon (pecking) (Kubo, 2010). Furthermore, acupuncture may also stimulate fibroblastic activity due to a mechanical signaling effect in response to a needle (Langevin, 2007). This may result in improved tissue healing and reverse the apoptosis of fibroblasts. We also know from an earlier study that acupuncture can bring about short term analgesia for tennis elbow (Green, 2002).
I have been experimenting with different needling techniques with my willing patients and the results have so far been positive. Let me know of your experiences.