High-volume injections didn’t fix Achilles tendon pain better than a sham at one year

High-volume injections, with or without a corticosteroid, didn’t improve Achilles tendon pain and function at 12 months compared with a sham injection in the Inject trial in Australia and New Zealand, published Oct. 28, 2026, in The BMJ. The steroid version did worse at 26 weeks.

Achilles tendinopathy causes pain and stiffness in the tendon at the back of the ankle, often in runners and active middle-aged adults. Exercise rehabilitation is the main treatment, but recovery can take months. Some clinics offer high-volume injections, a large amount of fluid injected around the tendon, sometimes with a corticosteroid.

What did the trial test?

192 adults with midportion Achilles tendinopathy were assigned by chance to one of three groups: a sham injection with a small amount of local anesthetic (64), a high-volume injection without a corticosteroid (63), or a high-volume injection with a corticosteroid (65). Neither participants nor assessors knew which. All received the same exercise program, education and activity advice. The main outcome was pain and function on the VISA-A scale at 52 weeks.

What did the study find about tendon pain?

• At 12 months, neither high-volume injection was clearly better than the sham.
• At six weeks, the injection with corticosteroid did better than the sham.
• At 26 weeks, the injection with corticosteroid did worse than the injection without it.
• The steroid injection was less costly than the sham over a year, with similar quality-adjusted life-years.
• There were no serious trial-related side effects.

Why does this matter?

A quick short-term improvement can make an injection seem like a success. This trial shows that, over a year, it didn’t beat a fake injection, and the steroid may even slow longer-term recovery. The authors conclude the results don’t support routine use of high-volume injections with corticosteroid.

How solid is this evidence?

It’s good. Mongevity rates it B on our A-to-E scale: a well-designed randomized trial with masking and 94% follow-up at 12 months. Limits: it was done at a single center, and the sham injection contained an anesthetic, so it wasn’t completely inactive.

What are the open questions?

It’s still unclear who, if anyone, benefits from injections, and whether other approaches can speed up recovery alongside exercise.

What does this mean for you?

If you have Achilles tendon pain, a structured, progressive loading exercise program, guided by a physiotherapist, is the best-supported first step. Ask about the trade-offs before agreeing to injections, especially with corticosteroids.

How do I explain this at dinner?

People with a painful Achilles tendon got either big-volume injections, with or without a steroid, or a fake shot, plus the same exercises. After a year, everyone did about the same, and the steroid shot helped at first but did worse later. A good question for the table: why can quick relief be misleading?

In one sentence: high-volume injections, with or without corticosteroid, didn’t improve Achilles tendinopathy more than a sham at 12 months, and the steroid version did worse later.