Hello. Thank you for reading my post. IRAP has not been clinically verified by a published multi million dollar study in the USA for tendons and ligaments. (Yet!) That is why it's contraindicated. Go to Europe and the answer will probably be different. I'll dig up a reference for this from a USA vet college. When my horse strained a sesmoidial I researched the daylights out of all this. My vet has said that many people would love to pay him to get their knees done but ethically that's not possible. But in Europe it is a procedure that may be had. Pharmaceutical companies have a strangle hold on medicine in this country. I have stock in a couple, best investments I've ever made. They have one or two top shelf drugs that bring in billions so why spend time figuring out a plan B when plan A is making so much money. Example: Type 2 diabetes is reversible in many cases, but insulin, test strips, specialty packaged junk foods, fancy drinks, etc., cost my dad's insurance a 1000 plus bucks a month. Out of pocket we probably pay 10 %. When he stopped drinking alcohol, limited junk food, and took a walk a day, his blood sugar went down to normal and he went off insulin. Done. And a couple months into not buying these products dad started getting robo calls about diabetes products. Then the coupons started showing up. This is a long winded explanation as to why IRAP isn't used. The cost analysis breakdown hasn't shown that it'll make enough money for all the right entities to put money into a study that will definitively show its effectiveness. Or lack of effectiveness. Because of the lack of studies in the USA, it's not recommended (in publications) as a treatment, in the USA, for several types of injuries we are indeed using it for in practical applications. I have injured knees and friends in Europe. In another few years I may be taking a trip. Extended holiday. Lots of rest and relaxation.