What is the best pain relief for a tendon injury?

Best Pain Relief for Tendon Injury

For tendon injury pain relief, a combination of relative rest, ice application, and appropriate analgesics is recommended, with topical analgesics being preferred over NSAIDs when possible due to fewer systemic side effects. 1

Understanding Tendon Injuries

• Most tendon injuries seen in clinical practice are degenerative in nature (tendinopathy/tendinosis) rather than truly inflammatory (tendonitis), affecting the rotator cuff, elbow epicondyles, patellar tendon, and Achilles tendon most commonly 1
• These injuries typically present as gradually increasing load-related localized pain that worsens with activity 1
• Approximately 80% of patients with overuse tendinopathies fully recover within three to six months with appropriate treatment 1

First-Line Pain Relief Strategies

Relative Rest and Activity Modification

• Reduce activities that worsen pain to prevent ongoing damage and promote healing 1
• Complete immobilization should be avoided as it can lead to muscle atrophy and deconditioning 1
• Continue activities that do not exacerbate symptoms to maintain function 1

Cryotherapy (Ice Application)

• Apply ice through a wet towel for 10-minute periods for optimal short-term pain relief 1
• Ice helps reduce tissue metabolism and may blunt inflammatory response in acute cases 1
• Repeated applications are most effective for pain management 1

Analgesics

• Topical analgesics should be considered first-line for pain control due to fewer systemic side effects 1
• Topical capsaicin can be applied as a thin film to the affected area 3-4 times daily (for adults and children over 18 years) 2
• Topical menthol may be applied 1-2 times daily, with optional warm pad application for 10 minutes afterward 3

Second-Line Pain Relief Options

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

• Both topical and oral NSAIDs effectively relieve tendinopathy pain in the short term but do not improve long-term outcomes 1
• Topical NSAIDs may provide pain relief with fewer systemic side effects compared to oral NSAIDs 1
• Caution: NSAIDs (except ibuprofen) may have detrimental effects on tendon healing by decreasing collagen content at the injury site 4

Corticosteroid Injections

• May provide better acute pain relief than oral NSAIDs but do not alter long-term outcomes 1
• Should be used cautiously as they may inhibit healing and reduce tendon strength, potentially predisposing to rupture 1
• Not recommended as first-line treatment due to potential negative effects on tendon healing 1

Rehabilitation for Long-Term Recovery

Eccentric Strengthening Exercises

• Essential component of tendinopathy treatment that may reverse degenerative changes 1
• Should be performed relatively pain-free to promote proper healing 5
• Has proven particularly beneficial for Achilles and patellar tendinopathy 1

Supportive Devices

• Orthotics and braces can reinforce, unload, and protect tendons during activity 1
• May help correct biomechanical problems contributing to tendon injury 1
• Selection should be based on the specific tendon affected and patient comfort 1

Common Pitfalls to Avoid

• Misdiagnosing tendinopathy as an inflammatory condition and relying solely on anti-inflammatory treatments 1
• Overreliance on corticosteroid injections, which may provide short-term relief but potentially compromise long-term healing 1
• Neglecting rehabilitation exercises, which are crucial for long-term recovery 5
• Complete immobilization of the affected area, which can lead to muscle atrophy and delayed recovery 1

Special Considerations

• Tendon healing is naturally slow due to low cellularity and vascularity of tendon tissue 6
• Most tendinopathies are degenerative rather than inflammatory in nature, which affects treatment approach 1
• Surgery should be reserved for patients who have failed 3-6 months of conservative therapy 1