From the Guidelines
Physiotherapy is a highly recommended treatment for tendinopathy, as it promotes collagen remodeling, improves tendon structure, and enhances blood flow to the affected area. Tendinopathy is a condition involving pain and dysfunction in tendons due to overuse or degeneration, and physiotherapy is considered a first-line treatment. A typical physiotherapy program for tendinopathy includes progressive loading exercises, starting with isometric exercises (holding contractions) before advancing to eccentric exercises (lengthening under tension), concentric exercises, and finally functional movements 1.
Key Components of Physiotherapy for Tendinopathy
- Progressive loading exercises to stimulate tendon healing and strengthen the surrounding muscles
- Eccentric strengthening, which has been shown to be an effective treatment for tendinopathy and may reverse degenerative changes 1
- Manual therapy techniques, such as massage and joint mobilization, to improve range of motion and reduce pain
- Shockwave therapy or taping to complement exercise therapy and enhance recovery
Duration and Frequency of Physiotherapy
Treatment typically requires 12-16 weeks of consistent therapy, with sessions 2-3 times per week initially, gradually decreasing as improvement occurs. Patients should expect gradual improvement rather than immediate relief, as tendon healing takes time. During recovery, activity modification is important to avoid aggravating the condition while maintaining appropriate loading to stimulate healing 1.
Additional Recommendations
- Relative rest and reduced activity to prevent further damage and promote healing and pain relief 1
- Cryotherapy, such as icing, to provide acute relief of tendinopathy pain 1
- Topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief, although they have no effect on long-term outcomes 1
From the Research
Tendinopathy and Physiotherapy
- Tendinopathy is a common and debilitating condition that can be treated with physiotherapy, including eccentric exercise-based physical therapy 2, 3, 4.
- Eccentric training has been shown to be effective in the treatment of tendinopathies, and can be used as a first line of treatment 3, 4.
- Physiotherapy, including exercise therapy, can be beneficial for tendinopathy, with studies showing improvements in pain and function 5.
- A combination of physiotherapy and other conservative modalities, such as injection or electro-therapy, may be more effective than physiotherapy alone 5.
Exercise Interventions for Tendinopathy
- Strengthening exercise is a common intervention for tendinopathy, with a combination of concentric and eccentric modes potentially being more beneficial than eccentric only 5.
- Flexibility and proprioception exercise may be beneficial for shoulder tendinopathy 5.
- Exercise interventions can be feasible and acceptable for patients with tendinopathy, but factors such as patient education and self-management should be considered 5.
Treatment Recommendations
- Eccentric exercise-based physical therapy should be considered as a first line of treatment for tendinopathy 2, 3, 4.
- Physiotherapy, including exercise therapy, can be a beneficial treatment option for tendinopathy, with a combination of physiotherapy and other conservative modalities potentially being more effective than physiotherapy alone 5.
- Surgical treatment procedures should only be considered in cases of failed response to conservative treatment 6.