What are the risk factors and treatment options for tendinitis?

From the Guidelines

Tendinitis is primarily caused by repetitive movements, overuse, poor posture, and sudden increases in physical activity, with common risk factors including age, certain occupations, sports participation, and medical conditions like diabetes and rheumatoid arthritis. The physiological predisposition that puts someone at risk for tendinitis includes:

• Repetitive strain on the tendons
• Poor posture and biomechanics
• Sudden increases in physical activity
• Age-related wear and tear on the tendons
• Certain medical conditions, such as diabetes and rheumatoid arthritis, which can affect tendon health 1 Treatment for tendinitis typically begins with the RICE protocol: rest the affected area, apply ice for 15-20 minutes several times daily, compress with an elastic bandage, and elevate the affected limb. Over-the-counter pain relievers, such as ibuprofen (400-800mg three times daily with food), naproxen (220-500mg twice daily), or acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily), can reduce pain and inflammation 1. Some key points to consider in the treatment of tendinitis include:
• Relative rest and reduced activity to prevent further damage and promote healing and pain relief 1
• Cryotherapy, such as icing, to provide acute relief of tendinopathy pain 1
• Eccentric strengthening exercises to promote tendon healing and prevent further injury 1
• The use of nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief, although they have no effect on long-term outcomes 1
• The potential use of corticosteroid injections for temporary relief, although these are limited to 2-3 injections per year due to potential tendon weakening 1
• The importance of physical therapy exercises to strengthen surrounding muscles and improve flexibility, which are crucial for recovery and prevention 1
• The consideration of surgical options, such as tendon repair or debridement, in severe cases unresponsive to conservative treatment 1

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Physiological Predisposition to Tendinitis

• Tendons transmit force between muscles and bones and, when stretched, store elastic energy that contributes to movement 2
• The tendinous portion of the gastrocnemius and soleus muscles merge to form the Achilles tendon, which is the largest and strongest in the body, but one of the most frequently injured 2
• Factors known to predispose patients to Achilles tendinitis include inadequate stretching, training errors, mechanical malalignment of the lower extremities, rigid training surfaces, and occasionally systemic disease 3
• Prospective studies indicate that risk factors for Achilles tendinopathy include female sex, black race, higher body mass index, prior tendinopathy or fracture, higher alcohol consumption, lower plantar flexion strength, greater weekly volume of running, more years of running, use of spiked or shock absorbing shoes, training in cold weather, use of oral contraceptives and/or hormone replacement therapy, reduced or excessive ankle dorsiflexion range of motion, and consumption of antibiotics in the fluoroquinolone class 4

Risk Factors for Tendinitis

• Excessive loading, insufficient recovery, and underpreparedness can increase injury risk by exposing athletes to relatively large changes in load 5
• Poor training technique and a variety of risk factors may predispose athletes to stress reactions that may be interpreted as possible precursors of stress fractures 5
• Overuse tendinopathy induces in the tendon pain and swelling with associated decreased tolerance to exercise and various types of tendon degeneration 5

Treatment Options for Tendinitis

• Conservative management options for chronic Achilles tendinopathy include eccentric (lengthening) exercises, extracorporeal shockwave therapy (ESWT), topical nitroglycerin, low level laser therapy, orthoses, splints or injections (e.g. corticosteroids, hyperosmolar dextrose, polidocanol, platelet-rich plasma) 2
• Nonsteroidal anti-inflammatory medication and corticosteroid injections may provide short-term relief but do not appear effective in the longer term 4
• Eccentric exercise and shock wave therapies are treatments with the highest evidence-based effectiveness 4
• Other conservative treatments that have been researched include stretching, orthotics, bracing, glyceryl trinitrate patches, and injection therapies (hyaluronic acid, platelet-rich plasma injections) 4