Why corticosteroid injections may not be a good treatment option for Achilles tendinopathy

THE INJECTION SERIES:

• Achilles tendonitis injection overview

• Why corticosteroid injections may not be a good treatment option for Achilles tendinopathy (this article)

• High Volume Injections as treatment for Achilles tendinopathy

• PRP injections for Achilles tendinopathy

• Hyaluronic acid for Achilles tendon pain

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Corticosteroid injections have traditionally been used for tendinopathies because they can provide excellent pain relief in the short term. However, in the long run they may be bad for your tendons.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

I've also discussed it in this video:

Corticosteroids increase the catabolic action (breakdown of cells) in tendons. In studies of the long-term effect of steroid injections on tendons, they found that the patients who received these injections were actually worse off (several months and years later) than the ones who received other types of care.

There’s currently a lack of good quality long term follow-up studies for the effect of corticosteroid injections specifically on Achilles tendons and Achilles tendinopathy. The current research suggests that you may be at a slightly higher risk of tearing your Achilles tendon after you’ve had a corticosteroid injection.

Summary of what we know about corticosteroids and tendons

• Steroids may weaken tendons by causing an increase in collagen breakdown.

• It provides very good pain relief in the short term (first 2 to 4 weeks).

• Tennis elbow is the only tendinopathy with high quality, long term follow-up studies and those show that, although steroids provide good pain relief for a few weeks, these patients are worse off after a few months. They found this to be the case at 6 months and 4 years post injection.

• High quality, long term follow-up studies for Achilles tendinopathy are currently lacking.

• The current research suggests that there may be a small increased risk of rupturing your Achilles tendon after you’ve had a corticosteroid injection.

My advice, as the research stands today, would be to stay away from steroid injections into your Achilles tendon or its sheath unless you’ve exhausted all other treatment options.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.

References:

1. Coombes, B. K., et al. (2010). "Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials." The Lancet 376(9754): 1751-1767.

2. Del Valle Soto, M., et al. "Consensus on the use of infiltration in sport. Document of Consensus of the Spanish Society of Sports Medicine."

3. Orchard, J. W., et al. (2018). "The use of ultrasound-guided injections for tendinopathies." Current Radiology Reports 6(10): 38.

4. Orchard, J. W. (2020). "Corticosteroid injections: glass half-full, half-empty or full then empty?" British Journal of Sports Medicine: bjsports-2019-101250.