What is the treatment for tendonitis (inflammation of the tendons)?

From the Guidelines

Treating tendonitis involves a combination of rest, medication, and gentle exercises, with the primary goal of reducing inflammation and promoting healing, as recommended by the American Family Physician in 2005 1. The treatment approach should prioritize relative rest and reduced activity to prevent further damage and promote healing and pain relief, as suggested by the evidence rating of C in the American Family Physician study 1. Key components of the treatment plan include:

• Resting the affected area and avoiding activities that cause pain
• Taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (250-500mg twice daily) for 1-2 weeks to reduce inflammation and pain
• Applying ice to the affected area for 15-20 minutes several times daily, especially after activity, as cryotherapy provides acute relief of tendinopathy pain 1
• Starting gentle stretching and strengthening exercises after the acute phase (2-3 days) to prevent stiffness and maintain function
• Considering physical therapy for persistent cases, focusing on eccentric strengthening exercises specific to the affected tendon, as it is an effective treatment of tendinopathy and may reverse degenerative changes 1
• Limiting the use of corticosteroid injections to severe cases due to potential tendon weakening, as locally injected corticosteroids may be more effective than oral NSAIDs for relief in the acute phase of tendon pain, but they do not tend to alter long-term outcomes 1 It is essential to note that the optimal treatment approach may vary depending on the specific case and the affected tendon, and consulting a healthcare provider is crucial if pain persists beyond 2-3 weeks despite these measures, as chronic tendonitis may require more specialized treatment.

From the FDA Drug Label

Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. Naproxen may also be used The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. The initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen. For relief of the signs and symptoms of tendonitis

The treatment for tendonitis is naproxen with a recommended starting dose of 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. The initial total daily dose should not exceed 1250 mg of naproxen, and thereafter, the total daily dose should not exceed 1000 mg of naproxen 2.

From the Research

Treatment Options for Tendonitis

• Eccentric exercises have been shown to provide excellent clinical results in both athletic and sedentary patients, with no reported adverse effects 3
• Combining eccentric loading and low-energy shock wave therapy can produce higher success rates compared to eccentric training alone or shock wave therapy alone 3
• High-volume injection of normal saline solution, corticosteroids, or anesthetics can reduce pain and improve long-term function in patients with Achilles or patellar tendinopathy 3

Use of Anti-Inflammatory Drugs

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat tendinopathy, but evidence for this treatment is lacking 4
• A study found that short-term ibuprofen treatment has no effect on gene expression in human chronic tendinopathic tendon or leads to any clear changes in tendon pain or function 4

Platelet-Rich Plasma (PRP) Therapy

• PRP can be clinically useful with a corticosteroid as a treatment for tendinopathy, as it can avoid the deleterious side effects of a corticosteroid 5
• PRP did not interfere with the anti-inflammatory effects of dexamethasone on tenocytes pretreated with IL-1β, but it increased the synthesis of tissue inhibitor of metalloproteinase (TIMP)-1 and -3 5
• A systematic review found that patellar tendons seem to benefit from PRP injections, whereas in the Achilles tendon, PRP application is not indicated neither as a conservative approach nor as a surgical augmentation 6

Post-Procedure Protocols for PRP Injections

• There is substantial heterogeneity in post-PRP protocols, with varying restrictions on movement and weight bearing, use of orthoses, activity modifications, and postinjection rehabilitation protocols 7
• The majority of protocols instituted a period of stretching and strengthening, with stretching programs generally beginning 2-7 days following injection, and strengthening programs beginning within 2-3 weeks 7