What are High-Volume Tendon Stripping Injections?

A High-Volume Tendon Stripping Injection involves injecting a high volume of saline (20ml) and a small amount of local anaesthetic (5ml) into the surrounding border of the tendon but not into the tendon itself. Steroid can also be injected if you choose, following detailed discussion with your clinician. The High-Volume Tendon Stripping Injection must be administered under ultrasound guidance for safety and accuracy.

What conditions are treated with High-Volume Tendon Stripping Injections?

High-Volume Tendon Stripping Injections are an appropriate treatment option for chronic Achilles and Patellar Tendon pain that has not responded to conservative management. In chronic tendon problems, extra blood vessels and nerve endings form in and around the affected portion of the tendon and it is thought that this contributes to the ongoing pain. It is thought that the pressure from the injection closes off the pathologic increased blood supply and nerve infiltration, leading to reduced pain.

Injection Therapist

Gareth Tremain

Our specialist physiotherapist Gareth Tremain completed a Masters degree module in 'Joint & Soft Tissue Injections' at Keele University in 2013 and has undertaken extensive training with specialist doctors, sonographers and consultant physiotherapists to hone his skills in Ultrasound-Guided Injections. He offers a range of Ultrasound-Guided Injections, including Cortisone, Hyaluronic Acid, High Volume and Hydrodilatation to treat a wide range of persistent injuries and chronic pain. Gareth will also advise you regarding the most appropriate exercise programme to complement your injection.

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How many Injections will I need?

1 injection is often enough to reduce pain and allow the patient to gradually build up level of activity and strength. Repeat injections are possible if required. Our physio will discuss this with you at your appointment.

What do I need to do following the Injection?

Following this procedure, you should minimise exercise such as running, long walks and leg weights for 2 weeks. Following the initial rest period, a gradual increase in exercise is recommended.

What does the Research Say?

The research shows variable results for these injections, but some studies have shown that High Volume Tendon Stripping Injections can produce lasting improvements in Achilles Tendon and Patellar Tendon pain that has not improved with conservative treatment. A recent study (Bosen et al, 2018) showed significantly improved results with the addition of a small amount of steroid (cortisone). The general opinion is that these injections should not be the first line of treatment for chronic tendon problems, but are worth considering if your function is still limited after a number of months of limiting exposure to aggravating activities and performing a graded tendon strengthening programme.