What is the role of intense pulsed light (IPL) in treating tendinopathy?

Intense Pulsed Light for Tendinopathy

Intense pulsed light (IPL) therapy is not recommended for the treatment of tendinopathy as high-quality evidence shows no measurable benefit compared to placebo. 1

Evidence Assessment

A double-blind randomized placebo-controlled trial specifically investigating IPL for Achilles tendinopathy found no significant difference between treatment and placebo groups for any outcome measures, including pain, function, and ultrasound measurements of tendon thickness and neovascularization 1. This represents the highest quality clinical evidence directly addressing the question.

While laboratory research has demonstrated that IPL can physically penetrate to the depth of the Achilles tendon in excised human tissue samples 2, this theoretical potential has not translated to clinical efficacy.

Recommended Treatment Approaches for Tendinopathy

According to current guidelines, the following evidence-based treatments should be prioritized for tendinopathy management:

First-line Treatments

• Eccentric strengthening exercises - Most consistently effective treatment for tendinopathy across systematic reviews 3, 4, 5
• Relative rest - Prevent further damage while promoting healing 3
• Cryotherapy - Applications of ice through a wet towel for 10-minute periods for acute pain relief 3

Second-line Treatments

• NSAIDs (oral or topical) - Effective for short-term pain relief but don't affect long-term outcomes 3, 4
• Acetaminophen - Up to 4g/day as first-line analgesic if NSAIDs are inadequate 4

Other Treatment Options

• Extracorporeal shock wave therapy (ESWT) - Shows moderate effectiveness but is expensive 3, 5
• Low-level laser therapy - Demonstrates moderate effectiveness when combined with exercise 5, 6
• Orthotics and braces - May help correct biomechanical problems 3, 4
• Corticosteroid injections - May provide short-term pain relief but should be used with caution as they don't alter long-term outcomes and may have deleterious effects 3, 4

Surgical Options

• Surgery should be reserved for patients who have failed 3-6 months of well-managed conservative therapy 3, 4
• Minimally invasive procedures are more effective than open surgical interventions 5

Treatment Protocol for Tendinopathy

1. Initial management (0-6 weeks):

   • Eccentric strengthening exercises
   • Relative rest with reduced activity
   • Cryotherapy for pain relief
   • NSAIDs or acetaminophen for pain control

2. Progressive rehabilitation (6-12 weeks):

   • Gradual increase in loading exercises
   • Progress from bilateral to single-leg exercises
   • Add resistance with weights or bands
   • Balance and proprioceptive training

3. Advanced rehabilitation (12+ weeks):

   • Sport-specific movement patterns
   • Plyometric exercises when pain-free
   • Gradual return to full activity (increase volume by no more than 10% per week)

Prognosis

Most patients (approximately 80%) fully recover within 3-6 months with appropriate conservative treatment 3, 4. Over 90% of cases have good outcomes with appropriate conservative management 4.

Important Considerations

• Despite the theoretical ability of IPL to penetrate tendon tissue 2, clinical trials show no benefit over placebo 1
• Eccentric exercises remain the gold standard treatment for tendinopathy 3, 4, 5
• The pathophysiology of tendinopathy involves degenerative changes rather than inflammation in most chronic cases, which may explain why treatments targeting inflammation have limited long-term efficacy 3