What can be taken orally to help with tendinosis?

Oral Treatment Options for Tendinosis

Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for short-term pain relief in tendinosis but have no effect on long-term outcomes. 1

First-Line Oral Treatments

• NSAIDs (such as ibuprofen) effectively relieve tendinopathy pain and may offer additional benefit in acute inflammatory tendonitis due to their anti-inflammatory properties 1
• Topical NSAIDs also reduce tendon pain and eliminate the increased risk of gastrointestinal hemorrhage associated with systemic NSAIDs 1
• For most chronic tendinopathies, which are primarily degenerative rather than inflammatory, NSAIDs primarily work as analgesics rather than addressing the underlying pathology 2

Important Considerations for NSAID Use

• NSAIDs provide pain relief in the short term, but their effectiveness for long-term healing has not been demonstrated 2
• Recent research suggests that ibuprofen may interfere with the normal healing process of tendon tissue by preventing the remodeling of inflammatory matrix components 3
• A 2017 study found that short-term ibuprofen treatment had no effect on gene expression in human tendinopathic tissue and did not lead to clear changes in tendon pain or function 4
• Patients with asthma should use NSAIDs with caution due to potential cross-reactivity with aspirin sensitivity 5

Alternative Approaches

• Eccentric strengthening exercises have proven beneficial in Achilles tendinosis and patellar tendinosis and may help other tendinopathies 1
• Cryotherapy (ice application) is effective for short-term pain relief; applications through a wet towel for 10-minute periods are most effective 1
• Relative rest to prevent ongoing damage while allowing activities that don't worsen pain 1
• Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 1

Adjunctive Treatments

• Orthotics and braces may be helpful for specific tendinopathies, though evidence is limited 1
• Extracorporeal shock wave therapy appears to be a safe, noninvasive option for chronic tendinopathies, though it can be expensive 1
• Nitric oxide patches have shown promise in early studies but require further research 2

When to Consider Other Interventions

• If oral medications and conservative measures fail after 3-6 months, surgical options may be considered 1, 6
• The presence of multiple symptomatic tendons should prompt evaluation for possible rheumatic disease 1

Cautions and Pitfalls

• Most tendinopathies are degenerative (tendinosis) rather than inflammatory (tendonitis), which may explain the limited long-term effectiveness of anti-inflammatory medications 2
• Locally injected corticosteroids may provide short-term relief but do not improve long-term outcomes and may have deleterious effects on tendon healing 1
• Ibuprofen may decrease tendon stiffness and elastic modulus, potentially weakening the tendon structure 3
• Avoid assuming that pain relief equals healing; symptom improvement with NSAIDs doesn't necessarily indicate resolution of the underlying tendon pathology 2