From the Guidelines
The treatment for mild tendinopathy primarily involves rest, activity modification, and a gradual rehabilitation program, with a focus on eccentric strengthening exercises, as this approach has been shown to be effective in promoting tendon healing and improving outcomes, as noted in the study by 1.
Key Components of Treatment
- Reduce activities that aggravate the tendon to prevent further damage and promote healing, as recommended by 1
- Apply ice to the affected area for 15-20 minutes several times daily to reduce inflammation, with repeated applications of melting ice water through a wet towel for 10-minute periods being most effective, as stated in 1
- Use over-the-counter pain medications like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) for short periods, typically 1-2 weeks, to manage pain and inflammation, as suggested by 1
Rehabilitation Program
- Begin gentle stretching and strengthening exercises after the acute phase, focusing on eccentric exercises where the muscle lengthens while under tension, as recommended by 1
- For example, with Achilles tendinopathy, slowly lower your heel off a step, taking 3-5 seconds for each repetition, performing 3 sets of 15 repetitions twice daily, as illustrated in the study by 1
- Gradually increase activity as pain allows, but avoid returning to full intensity too quickly, to prevent re-injury and promote continued healing, as advised by 1
Additional Considerations
- Physical therapy can provide personalized exercise programs and may include techniques like massage or ultrasound, as noted in the study by 1
- Proper footwear or orthotic devices may help reduce strain on the affected tendon, as suggested by 1
- Most mild tendinopathy cases improve within 6-12 weeks with consistent treatment, as reported in the study by 1 This approach works because it allows the tendon to heal while gradually increasing its load tolerance, addressing the underlying cause of tendinopathy, which is typically overuse or improper loading of the tendon, as explained in the study by 1.
From the Research
Treatment Options for Mild Tendinopathy
- A reasonable first line of treatment for tendinopathy should include a course of NSAIDs and eccentric exercise-based physical therapy 2
- Eccentric exercises provide excellent clinical results both in athletic and sedentary patients, with no reported adverse effects 3
- Combining eccentric loading and low-energy shock wave therapy produces higher success rates compared with eccentric training alone or shock wave therapy alone 3
Role of Injections in Treatment
- Corticosteroid injections seem to offer excellent short-term pain relief but lack long term efficacy 2
- High-volume injection of normal saline solution, corticosteroids, or anesthetics can reduce pain and improve long-term function in patients with Achilles or patellar tendinopathy 3
- Platelet-rich plasma injections have shown mixed results, and evidence-based recommendations on its efficacy cannot be made 4
Surgical Intervention
- Operative management seems to offer some benefit in symptomatic relief but carries a higher complication rate than other treatment options and should be reserved only for patients recalcitrant to other more conservative options 2
- Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities 4
Conservative Management
- Conservative treatment is effective in the management of hip tendinopathies and may be considered the first-line approach for patients affected 5
- Exercise therapy seems to provide long-term pain relief, but the literature is still lacking about the correct type, dose, posology, intensity of exercise prescribed 5
- A variety of non-surgical treatment options are available, including nonsteroidal anti-inflammatory drugs, corticosteroid, eccentric exercise, extracorporeal shock wave therapy, therapeutic ultrasound, hyaluronic acid, platelet-rich plasma, prolotherapy, polydeoxyribonucleotide, and stem cells 6