For Stubborn Achilles Pain, Fluid Injections Didn’t Beat a Sham

CATEGORY: MOBILITY, BONES & JOINTS

The injections didn’t work. In a yearlong Australian trial of 192 adults with long-running Achilles tendon pain, a high-volume fluid injection, given with or without a steroid, ended up no better than a sham procedure. The trial was built to detect a ten-point difference on the standard 100-point score of Achilles pain and function, and at twelve months no comparison came close: every group sat within a few points of the sham.¹

A Bigger Syringe for a Tendon That Won’t Heal

Midportion Achilles tendinopathy is an overuse injury of the thick cord above the heel. It can mean months of pain with every run, stair and first morning step. When exercise therapy stalls, one popular next step is the high-volume injection: a large dose of saline, several times the size of an ordinary shot, pushed between the tendon and the tissue in front of it to strip away the tiny blood vessels and nerve endings that creep into a sore tendon. People in this trial had typically hurt for two years. All 192 got the same 12-week strengthening program. Alongside it, a third received the high-volume injection, a third got the same injection plus a corticosteroid (an anti-inflammatory drug), and a third got a sham procedure. Who got which syringe was decided at random, and neither the patients nor the staff scoring their recovery knew.

A Six-Week Head Start That Melted Away

The steroid version did do something, briefly. At six weeks, people who’d received it scored about nine points better than the sham group. That’s a difference big enough to feel. By six months the picture had reversed, and the steroid arm trailed the plain-fluid arm by almost nine points. At one year, nothing separated the three groups. Strangely, the steroid injection still looked like good value on paper: because its recipients felt better early and used less other care, it cost less than the sham with similar overall benefit. The researchers’ conclusion didn’t budge. The longer-term scores, they wrote, don’t support routine use.¹ No serious side effects tied to the treatments were recorded.

Another Needle, Same Verdict

This isn’t the first injection to fail a sham test. In 2021, a British trial gave 240 people with the same condition either platelet-rich plasma, made from a patient’s own blood, or a sham needle; six months later the groups were about three points apart on the same 100-point score.² What the new trial can’t tell us is whether other treatments behave the same way, since it tested one specific technique, in one clinic, against a convincing fake. For a tendon problem that often outlasts a first round of exercise therapy, that fake held its own for a full year.

Key Takeaways

• High-volume injections, with or without a steroid, didn’t improve Achilles pain or function more than a sham over a year of follow-up.
• The steroid gave a real but short-lived boost: ahead of the sham at six weeks, behind the plain injection by six months, even at a year.
• The verdict covers one technique for midportion Achilles pain. It says nothing about other tendon problems or other kinds of shots.

References

1. Malliaras P, Connell D, Boesen AP, et al. Efficacy and cost effectiveness of high volume injections with and without corticosteroid compared with sham for midportion Achilles tendinopathy (Inject trial): randomised controlled trial. The BMJ. 2026;395:e100807. link
2. Kearney RS, Ji C, Warwick J, et al. Effect of platelet-rich plasma injection vs sham injection on tendon dysfunction in patients with chronic midportion Achilles tendinopathy: a randomized clinical trial. JAMA. 2021;326(2):137–144. link