July 28, 2003 -- Using electric current to deliver steroids directly to strained tendons is a promising treatment for tennis elbow and other overuse injuries. A new study shows for the first time that the strategy controls pain effectively, allowing patients to begin rehabilitation exercises sooner.
Researcher Robert P. Nirschl, MD, tells WebMD that effective rehabilitation is key to preventing future injuries. He says clinicians often counsel patients to rest and take anti-inflammatory pain medications for tendon strains like tennis elbow, but such treatments do nothing to prevent re-injury.
"Rest and pain pills can make you comfortable, but comfort is not a cure," he says. Nirschl is a well-known expert in the treatment of sports injuries, and is director of the Nirschl Orthopedic and Sports Medicine Clinic in Arlington, Va.
Patients can prevent re-injury by doing strength, endurance and flexibility exercises to revitalize weakened tendons, Nirschl says, and delivering the steroid cortisone to strained tendons using an electrical delivery system known as iontophoresis allows many patients to start rehabilitation exercises soon after injury.
Nirschl and his colleagues presented results from a study involving 199 patients with tennis elbow at the annual meeting of the American Orthopaedic Society for Sports Medicine held in San Diego, Ca. last week. He says the findings could have implications for as many as 100 million people who participate in sports, exercise regularly, or work in jobs where tendon strains and overuse injuries can occur.
Like birth control and anti-smoking skin patches, iontophoresis involves the delivery of medication directly through the skin. But the use of low-level current allows the medication to be delivered more quickly than with ordinary patches and with less side effects than steroid injections into the joints.
The study compared iontophoretic steroid delivery to electrical stimulation alone. It found that patients who received cortisone through iontophoresis had much better pain control early in treatment. The difference was not as significant a month later, however. Patients who had six cortisone treatments in 10 days or less also had earlier and better pain control than those who spread the treatments out over a longer period.
Nirschl says people with tendon overuse injuries can begin exercising immediately after injury to strengthen the weakened area, as long as the tendon is not torn. Exercise promotes the production of collagen, which he calls the healing glue for degenerating tendons. Exercise also causes the formation of new blood vessels.
"Some physical therapists have been using [iontophoretic steroid delivery] for a while, but this is the first study to confirm that it works," Nirschl says. "Revitalizing degenerated tissue is the cure for overworked tendons, and iontophoresis allows us to effectively control the pain so patients can do the exercises."
Study co-author Derek H. Ochiai, MD, agrees that resting strained muscles does little to cure the underlying weakness that causes injury.
"Rehabilitation must be done to change and strengthen that tissue," Ochiai said in a press statement. "The goal is revitalization through nutrition and new collagen production plus strength, endurance, and flexibility."