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Old 02-14-2010, 06:19 PM   #1
Howell Hsieh
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Default Nitroglycerin to treat tendinosis/tendinopathies

Hello,

Has anyone had any experiences with using transdermal nitroglycerin patches to treat tendon related injuries?

I had chronic knee pain (patellar tendonitis/tendinosis) for over a year, found out about these patches, and 2 weeks later my symptoms were gone (actually I feel like they started noticeably reducing the pain 24-48 hours after the start of patching, but 2 weeks is probably how long it took for their effect to taper off). I did utilize a full rehab routine as well, lots of stretching and foam rolling, but I would attribute 85% of my recovery to these patches.

A few months later, I developed medial epicondylitis about my right elbow. I did a full rehab for a while without much success, but once I patched the area, voila...!

General overview link:
http://bjsm.bmj.com/content/41/4/227.full wfs

Now I am having shoulder issues (chronic), but the patches aren't working as well...probably because there are many layers of muscles in this region, and it's hard to patch directly over a tendon without muscles getting in the way.
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Old 02-14-2010, 06:49 PM   #2
Steven Low
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That's pretty interesting.. I'll have to look into this further.

Your shoulder issues may not just be because of tendonitis though. The shoulder is complex enough that often it's posture, biomechanics, limited mobility or imbalances that often screw things up there rather than strict tendinopathy in most cases.

Medial epicondylitis, and patellar tendinitis tend can be just overuse but are less likely in most cases to have lots of other things go wrong with them compared to the shoulders and for another example the low back.
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Old 02-14-2010, 07:24 PM   #3
Howell Hsieh
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Yeah, it's definitely possible that other issues are responsible here. I think scapular mobility and flexibility is fairly decent though. I will post some pictures later of posture.

The problem is that when I try to patch over the affected shoulder area, I get a different reaction than when I patch over the knee or elbow. In the case of the patellar region, it is pretty much impossible to miss hitting the patellar tendon, in fact, I hit different portions of the tendon so as not to "overwork" one spot too much. In the elbow, if I patched too close to the triceps, it would feel slightly painful and ineffective. If I patched directly onto a tendon, I might get a slight itching sensation, but no pain - basically I could very easily tell if I was patching over a tendon or not.

In the case of my shoulder, the pain is not very localized (anterior region, I am guessing bicipital tendon?)... so I am doing my best to get a fix on the area of pain, but I am pretty sure I am patching over muscle overlying the tendon, because it starts hurting pretty soon (1-2 hours) after I patch. It's hard to say how much exactly, but I am guessing just a minimal amount of NO is getting to the area.
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Old 02-15-2010, 06:51 AM   #4
Garrett Smith
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If the pain isn't completely gone after using the patches and eventually comes back, then all you are doing is treating a symptom. Not much better than NSAIDS, IMO.
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Old 02-15-2010, 06:03 PM   #5
Howell Hsieh
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From what I understand, the premise of using NO to treat tendons is very different than NSAIs. One, it dilates the blood vessels so that whatever minimal blood vessels are present in the tendons receive more blood flow, and two, it attracts fibroblast cells to the area which are responsible for the creation of new collagen fibers. It's a transdermal patch that works locally and not globally.

Anyway, it's interesting to me that more people don't know about it, given just how cheap it is... (~$40 for a 3+ month's supply). The problem was that the only doc I knew who prescribed it was halfway around the country, so prescription + plane tickets was a bit more than $40! Don't get me wrong though, it was worth its weight in gold!
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Old 02-16-2010, 12:20 PM   #6
Jason Lopez-Ota
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This is interesting. So it works?
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