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Thus, the exception: the patient with chronic soft-tissue damage, inflammation or whos in the midst of post-injury repair

Damage to the tubular endothelial cells can increase leukocyte adhesion, platelet aggregation, and vasoconstriction, reduce blood flow to nephrons, and damage the glomerular barrier and the extensive network of peritubular capillaries (88)

The mechanistic rationale for adjunctive use is strong

A second pathway, ERK1/2 signalling, governs cell survival and fibroblast activity, and appears especially relevant in tissue thats naturally poor in blood supply, tendons and ligament junctions being the clearest examples (Rodgers et al., 2025)