What is the treatment for tendinosis?

From the Guidelines

Treatment for tendinosis should prioritize a combination of rest, eccentric strengthening exercises, and pain management to promote healing and reduce morbidity, mortality, and improve quality of life. The initial approach involves reducing activities that aggravate the affected tendon, allowing it to heal. Physical therapy exercises, particularly those focusing on eccentric strengthening, are effective for tendinosis recovery 1. For pain relief, over-the-counter medications like ibuprofen or naproxen can help manage discomfort, though they should be used for short periods to avoid side effects. Applying ice to the affected area can reduce inflammation.

Some key considerations for treatment include:

• Relative rest and reduced activity to prevent further damage and promote healing and pain relief 1
• Eccentric strengthening as an effective treatment that may reverse degenerative changes 1
• Use of NSAIDs for short-term pain relief, but with awareness of their lack of effect on long-term outcomes 1
• Consideration of topical NSAIDs for their effectiveness and potentially fewer systemic side effects 1
• The role of locally injected corticosteroids for acute-phase pain relief, though they do not alter long-term outcomes 1

Treatment Options

For persistent cases, various treatment options can be considered:

• Corticosteroid injections may provide temporary relief but should be used judiciously to avoid weakening the tendon 1
• Extracorporeal shock wave therapy appears to be a safe and effective, though expensive, means of pain relief for chronic tendinopathies 1, 2
• Surgery is an effective option in carefully selected patients who have failed conservative therapy, involving excision of abnormal tendon tissue and release of areas of scarring and fibrosis 3

Recovery and Prevention

Recovery from tendinosis is typically slow, taking 3-6 months, due to the limited blood supply of tendons. Gradually returning to normal activities and addressing biomechanical issues through proper equipment, technique correction, or orthotics can help prevent recurrence and improve quality of life. Technique modification for athletes and manual laborers aims to minimize repetitive stresses on tendons, promoting healing and preventing future problems 2.

From the Research

Treatment Options for Tendinosis

• Eccentric exercise has the strongest evidence of therapeutic efficacy for treating tendinosis 4, 5
• Extracorporeal shock wave treatment shows promising early results but requires long-term studies 4, 5
• Sclerosing agents have promising early results but require long-term studies 4, 5
• Nitric oxide patches show promising early results but require long-term studies 4, 5
• Platelet-rich plasma injections have encouraging short-term results, but larger and longer-term clinical trials are needed to assess this promising modality 4, 5, 6
• Corticosteroid and nonsteroidal anti-inflammatory medications have not been shown to be effective, except for temporary pain relief for rotator cuff tendinopathy 4, 5, 7
• Matrix metalloproteinase inhibitors have had few clinical studies, and their role in the treatment of tendinosis is still in the early phase of investigation 4

Post-Procedure Protocols for Platelet-Rich Plasma Injections

• Weight-bearing restrictions are rarely mentioned after PRP injection 6
• Orthosis use is uncommon overall, but more common in Achilles tendinopathy protocols 6
• Stretching and strengthening programs are commonly instituted after PRP injection, with stretching programs generally beginning 2-7 days following injection and strengthening programs beginning within 2-3 weeks 6
• Preinjection NSAID restriction is reported rarely, whereas postinjection NSAID restriction is more common, with a typical restriction of greater than 2 weeks 6
• Return to play or full activity is reported in 42% of protocols, most commonly at 4-6 weeks following injection 6

Other Treatment Modalities

• Nonsteroidal anti-inflammatory drugs, corticosteroid, therapeutic ultrasound, hyaluronic acid, prolotherapy, polydeoxyribonucleotide, and stem cells are also being studied as potential treatment options for tendinopathies 8