What are the treatment options for tendinitis?

From the Guidelines

Treatment for tendinitis should prioritize rest, physical therapy, and pain management with over-the-counter medications, with surgical options considered only after conservative treatment has failed for 6-12 months. The most effective treatment approach for tendinitis involves a combination of non-surgical and surgical methods, focusing on reducing inflammation, promoting healing, and strengthening the affected area to prevent recurrence.

Key Treatment Options:

• Rest and avoidance of activities that cause pain, allowing the inflamed tendon to heal 1
• Over-the-counter pain medications like ibuprofen, naproxen, or acetaminophen to reduce pain and inflammation for 1-2 weeks 1
• Physical therapy exercises to strengthen surrounding muscles and improve flexibility, typically performed daily for 4-6 weeks 1
• Ice therapy to reduce inflammation, especially after activity 1
• Supportive devices like braces, splints, or orthotics to reduce stress on the affected tendon during healing 1
• Corticosteroid injections for temporary relief in persistent cases, limited to 2-3 injections per year due to potential tendon weakening 1

Surgical Options:

• Tendon repair or removal of damaged tissue for severe or persistent tendinitis not responding to conservative treatment after 6-12 months 1 It's essential to note that while corticosteroid injections can provide temporary relief, their long-term effects on tendon health are still debated, and they should be used cautiously 1. Additionally, surgical options should be considered only after conservative treatment has failed, as they carry inherent risks and complications 1.

Recent Guidelines:

The most recent guidelines from 2019 recommend physical therapy as a strong treatment option for adults with active ankylosing spondylitis and nonradiographic axial spondyloarthritis, with a moderate level of evidence 1. These guidelines also conditionally recommend locally administered parenteral glucocorticoids for active enthesitis and peripheral arthritis despite treatment with NSAIDs, with a very low level of evidence 1. Overall, a comprehensive treatment plan for tendinitis should prioritize conservative management, with surgical options reserved for severe or persistent cases that do not respond to non-surgical treatments.

From the FDA Drug Label

Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. Naproxen may also be used The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.

• Treatment options for tendinitis include the use of naproxen, with a recommended starting dose of 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required 2.
• The initial total daily dose should not exceed 1250 mg of naproxen, and thereafter, the total daily dose should not exceed 1000 mg of naproxen.
• Naproxen sodium is recommended for the management of acute painful conditions, such as tendinitis, when prompt onset of pain relief is desired 2.

From the Research

Tendinitis Treatment Options

• The treatment of tendinitis is a complex process, and the ideal approach remains unclear 3
• Traditional treatment methods, such as anti-inflammatory drugs and steroid injections, may not significantly affect the natural history of the condition 4
• Some studies suggest that eccentric strengthening protocols, sclerotherapy, and nitric oxide patches may be effective in treating tendinopathy, but larger trials are needed to confirm these findings 3
• Conservative management options, including eccentric exercises, extracorporeal shockwave therapy, and topical nitroglycerin, may be effective in managing chronic Achilles tendinopathy 5
• Combining eccentric loading and low-energy shock wave therapy may produce higher success rates compared to eccentric training alone or shock wave therapy alone 6

Medical Interventions

• Anti-inflammatory medications, such as NSAIDS and corticosteroids, may provide short-term pain relief, but their long-term effectiveness has not been demonstrated 3
• Injectable substances, such as platelet-rich plasma, autologous blood, and corticosteroids, are not supported by strong clinical evidence 6
• High-volume injection of normal saline solution, corticosteroids, or anesthetics may reduce pain and improve long-term function in patients with Achilles or patellar tendinopathy 6

Therapeutic Exercise

• Eccentric exercises have been shown to promote symptom resolution and functional recovery in many patients with tendinopathy 7
• Loading of the tendon through exercise, especially exercise involving eccentric muscle contraction, may be an effective treatment approach 7
• Therapeutic exercise, combined with other conservative management options, may be a effective way to manage tendinopathy 6