What can treat tendinosis pain?

Treatment Options for Tendinosis Pain

Eccentric strengthening exercises are the most effective treatment for tendinosis pain, with strong evidence supporting their use to reverse degenerative changes and promote symptom resolution. 1, 2, 3

First-Line Treatment Approaches

Conservative Management

• Activity Modification:

  • Technique modification to minimize repetitive tendon stress 1
  • Avoid activities that cause pain and implement relative rest 1
  • Use of orthotics and braces to correct biomechanical problems 1

• Physical Interventions:

  • Cold application: Apply ice wrapped in damp cloth for 20-30 minutes, 3-4 times daily 1
  • Compression wrap for comfort (without compromising circulation) 1

• Exercise Therapy (highest evidence of efficacy):

  • Eccentric strengthening exercises - most effective intervention with strongest evidence 1, 2, 3
  • Implement a phased rehabilitation approach:
    1. Initial phase (0-4 weeks): Pain control and protected range of motion
    2. Intermediate phase (4-8 weeks): Progressive strengthening and eccentric training
    3. Advanced phase (8-12 weeks): Occupation-specific training and functional exercises 1

Pharmacological Management

• NSAIDs: Recommended only for short-term pain relief
  • Ibuprofen 1.2g daily initially, can increase to 2.4g if needed
  • May combine with paracetamol (up to 4g daily) for enhanced relief
  • Important caveat: NSAIDs have no effect on long-term outcomes and basic science studies raise concerns about their use 1, 3, 4

Second-Line Treatment Options

Minimally Invasive Procedures

• Extracorporeal Shock Wave Therapy (ESWT):

  • Uses acoustic shock waves to promote tendon healing
  • Safe and effective for calcific tendinopathy
  • Mixed evidence requires further study of energy and application protocols 1, 2, 3

• Ultrasound-guided needle lavage:

  • Effective for symptom relief and calcium deposit removal in calcific tendinopathy 1

• Therapeutic ultrasound:

  • May decrease pain and increase collagen synthesis
  • Evidence for consistent benefit is weak 1

• Corticosteroid injections:

  • Limited use recommended (2-3 injections, 4-6 weeks apart)
  • Provides short-term relief but does not improve long-term outcomes
  • Warning: Peri-tendon injections of patellar and quadriceps tendons should be avoided due to risk of tendon rupture 1, 5, 3
  • Dosage must be individualized based on disease severity and patient response 5

Emerging Treatments

• Sclerosing injections:

  • Promising early results but require long-term studies 2, 3

• Nitric oxide patches:

  • Promising in basic science studies
  • Clinical efficacy not well established 2, 3

• Platelet-rich plasma injections:

  • Encouraging short-term results
  • Larger and longer-term clinical trials needed 2

Surgical Intervention

• Consider if pain persists despite 3-6 months of well-managed conservative treatment
• Typically involves excision of abnormal tendon tissue and longitudinal tenotomies
• Short-term results are frequently good, but long-term follow-up shows possible deterioration over time 1, 6
• Should be the last option due to morbidity and inconsistent outcomes 3

Treatment Monitoring and Follow-up

• Regular assessment at 2,6, and 12 weeks to evaluate:

  • Pain levels
  • Range of motion
  • Functional improvement
  • Signs of recurrent instability 1

• Return to full activity permitted when patient demonstrates:

  • Complete resolution of pain
  • Full range of motion
  • Strength symmetry >90% compared to uninjured side
  • Successful completion of occupation-specific functional tests 1

Common Pitfalls to Avoid

• Prolonged immobilization beyond 3 weeks can lead to contractures 1
• Relying solely on NSAIDs or corticosteroids without implementing exercise therapy 2, 3, 4
• Failing to progress through a structured rehabilitation program 1
• Returning to full activity too soon before adequate healing 1
• Surgical biopsy or removal of ossifications may trigger development of more lesions 1