For decades, the medical world treated tendon pain as "Tendinitis"—an inflammatory condition requiring rest and anti-inflammatories. However, modern research over the last decade has completely shifted this paradigm. Today, we understand that most chronic tendon pain is actually Tendinopathy—a degenerative process characterized by a failure of the tissue's self-healing mechanism. In this article, we will explore how Orthopedic Dry Needling, specifically the Percutaneous Needle Tenotomy (PNT) technique, serves as the "spark" that restarts the healing process in the tendon.

 

The Pathophysiology of the Chronic Tendon

In tendinopathic conditions, histological examinations reveal the breakdown of collagen fibers, an increase in ground substance, and the abnormal growth of small blood vessels and nerves (Neovascularization). The tendon becomes thickened, less elastic, and highly sensitive to load. The central issue is that the tissue is "stuck" between the inflammatory and repair phases, unable to produce healthy Type 1 collagen.

 

Mechanism of Action: Mechanical Stimulation for Healing

Orthopedic needling for tendons acts as a controlled "micro-trauma." Inserting the needle directly into the damaged tendon tissue or the tendon-bone interface (Enthesis) triggers several simultaneous actions:

1. Mechanical Disruption: The needle physically breaks down adhesions and micro-calcifications within the tendon.
2. Controlled Local Bleeding: This bleeding brings platelets that release Growth Factors (such as TGF-beta and PDGF), which are essential for stimulating fibroblasts to produce new collagen.
3. Immune System Stimulation: The needling converts a "dormant" chronic state into a temporary acute state, forcing the body to recruit white blood cells and macrophages to debride the damaged tissue.

 

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Research Evidence: From Tennis Elbow to Achilles Tendon

Recent Randomized Controlled Trials (RCTs) and meta-analyses support the use of Dry Needling for tendons. A study by Uygur et al. (2017) demonstrated that dry needling was as effective as steroid injections for treating Lateral Epicondylitis (Tennis Elbow) in the long term, without the side effects of tissue atrophy.

Additional studies on Patellar and Achilles tendinopathy show significant improvements in pain and function scores (VISA-A/P) following a series of needling treatments.

 

Clinical Integration: Needling as Part of a Loading Protocol

It is crucial to emphasize: Dry Needling does not stand alone. As we teach at Manual IL, needling provides the "therapeutic window." Once pain is reduced and blood flow to the tendon is improved via the needles, it is the critical time to introduce graded mechanical loading (Eccentric or HSR protocols). The combination of mechanical needle stimulation and functional loading is the key to remodeling the tendon.

 

Orthopedic Dry Needling Course – Details and Curriculum

 

Summary

Treating tendons requires patience and precision. Orthopedic Dry Needling allows us to address the source of the problem directly, awaken the missing biological response, and pave the way for full rehabilitation. Expertise in topographical anatomy is a prerequisite for safely performing this technique, especially in areas adjacent to joints and major blood vessels.