What are the recommended over-the-counter (OTC) treatments for tendinitis?

Recommended OTC Treatments for Tendinitis

The most effective over-the-counter treatments for tendinitis include relative rest, ice therapy, oral or topical NSAIDs, and eccentric strengthening exercises. 1, 2

First-Line OTC Treatments

Relative Rest and Activity Modification

• Reduce repetitive loading of the affected tendon while maintaining some activity to prevent muscle atrophy 1
• Complete immobilization should be avoided as it can lead to deconditioning 1
• Most patients with tendinopathy (approximately 80%) recover within 3-6 months with appropriate conservative treatment 1

Cryotherapy (Ice Therapy)

• Apply ice through a wet towel for 10-minute periods to provide short-term pain relief 1
• Ice therapy reduces tissue metabolism and may blunt inflammatory response in acute cases 1
• Particularly effective for acute inflammatory tendinitis by reducing swelling and pain 1

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• Both oral and topical NSAIDs effectively relieve tendinopathy pain in the short term 1
• Topical NSAIDs may be preferable due to fewer systemic side effects 1
• NSAIDs should be used at the lowest effective dose for the shortest possible period 3
• While effective for pain relief, NSAIDs have not been shown to improve long-term outcomes 4

Eccentric Strengthening Exercises

• Proven beneficial for Achilles and patellar tendinopathy and may help other tendinopathies 1
• Can reverse degenerative changes in the tendon tissue 2
• Should be performed regularly as part of a rehabilitation program 1

Adjunct OTC Treatments

Local Heat Applications

• May be beneficial as an alternative to ice therapy, especially for chronic cases 1
• Can improve blood flow and promote healing in non-acute phases 1

Braces and Supports

• Tennis elbow bands, shoe orthotics, and other supports can reinforce and protect tendons during activity 1
• Helpful in correcting biomechanical problems such as excessive foot pronation 1
• Consider for joints with biomechanical instability or pain 1

Treatment Algorithm

1. Initial Phase (First 1-2 weeks)

   • Relative rest - reduce activities that aggravate symptoms 1
   • Ice therapy - 10-minute applications several times daily 1
   • OTC NSAIDs (oral or topical) - use for short-term pain relief 1, 3

2. Rehabilitation Phase (Weeks 2-12)

   • Continue relative rest with gradual return to activity 1
   • Begin eccentric strengthening exercises 1
   • Consider braces or supports during activity 1
   • Continue NSAIDs only if necessary for pain control 4

3. Advanced Phase (Beyond 12 weeks)

   • Progressive return to full activity with proper technique 2
   • Maintenance eccentric exercises 1
   • Consider medical evaluation if symptoms persist beyond 3-6 months 1

Important Considerations and Pitfalls

• NSAIDs should not be used for more than 10 days without consulting a healthcare provider 3
• NSAIDs carry risks including gastrointestinal, liver, and cardiovascular side effects, especially with prolonged use 3
• Recent research suggests tendinopathy often involves little or no inflammation, which may limit the effectiveness of anti-inflammatory treatments 5, 6
• Technique modification for athletes and manual laborers is important to minimize repetitive stress on tendons 1
• If symptoms persist despite 3-6 months of well-managed conservative treatment, further medical evaluation may be warranted 1, 2