If a day is a long time in politics, then try 6 hours on Twitter. After posting my blog "Why the Double Standard in Tendinopathy Research", I got inundated with tweets, texts and emails-some positive but a lot negative. I was even tweeted by the venerable bjsm; and if you read between the lines, there's more conspiracy in the bjsm's tweets about PRP than an episode of Real Housewives of Melbourne. So like bottom-side Leicester City coming back to take a beating from top-side Chelsea, I thought I'd add a follow up blog not only to come back for a beating but to offer a plea to those researchers among you.
First, I'm no bastion of PRP. I agree with the BJSM's spin of PRP as voodoo or shazam medicine. My point of the blog was to expose the unequal scrutiny in research. And let's give a bit of credit where credit is due: there's evidence coming in thick and fast (albeit lower level evidence) that many are getting results with PRP. I've not done the sums but it seems that PRP studies are outnumbering the loading studies. I'll leave it up to you to ponder the reasons why, but I suspect you might find the answer in shareholder report of a multinational pharmaceutical company.
Second, has anyone given thought as to why there's a proliferation of voodoo treatments? Try PRP with activator, stem cell implantation, and the daddy of them all, bone marrow aspiration (try drilling a hole through your iliac crest!). I have one suggestion: the clinicians at the coalface are not getting the results that you, researchers and experts, say we should be getting. There is a sizeable subset of patients/athletes who don't improve with tendon loading program based on current thinking. They'll try anything to get better and the medical machine is willing to provide this service at a cost. If you don't believe me, attend the AFAP conference (www.afap.org.uk) on 21st March and speak to those therapists at the coalface. I bet most will agree with me.
It's not good enough to say that the best evidence comes from loading. We know it works, but we need something better than a general statement. It's not good enough to say that as every tendon and patient is different, you can't provide more concise guidance. That's even more reason to do further research. If you believe that your method gets great results, do the clinical studies and publish the results. If you believe that single-intervention RCTs are inadequate for tendinopathy, then perform a study using general principles and pick a journal that will be pragmatic. We need more Silbernagels and Kongsguards. Where are you? We are crying out for good quality practical studies that demonstrate efficiency and effectiveness of exercise and loading. Let us help our difficult tendon patients. Perhaps then we can stop this voodoo madness.