From the Guidelines
Physiotherapy is a highly recommended treatment for tendinopathy, as it has been shown to be effective in promoting tendon healing and improving patient outcomes. The most recent and highest quality study 1 suggests that eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes. A typical physiotherapy program for tendinopathy includes:
- Progressive loading exercises, starting with isometric exercises (holding contractions) before advancing to eccentric exercises (lengthening under tension), and finally to heavy slow resistance training
- Treatment typically requires 8-12 weeks of consistent therapy, with sessions 2-3 times per week, complemented by home exercises
- Physiotherapists may also incorporate manual therapy techniques, shockwave therapy, or taping depending on the specific tendinopathy This approach is effective because controlled loading stimulates tendon healing by promoting collagen synthesis and improving the alignment of tendon fibers, while also enhancing blood flow to the affected area. Pain reduction typically occurs within 4-6 weeks, though full functional recovery may take 3-6 months depending on the severity and location of the tendinopathy. Additionally, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended for short-term pain relief, but they have no effect on long-term outcomes 1. Overall, physiotherapy is a crucial component of tendinopathy treatment, and its implementation should be prioritized to improve patient outcomes and reduce morbidity and mortality.
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.
- Physiotherapy is considered a first-line treatment for tendinopathy, with eccentric exercise being the cornerstone of treatment 2, 3, 4.
- Exercise therapy, including strengthening and flexibility exercises, has been shown to be safe and beneficial for tendinopathy, with patients generally satisfied with treatment outcomes 5.
- The combination of eccentric and concentric strengthening exercise may be most beneficial for tendinopathy, particularly when combined with another conservative modality such as injection or electro-therapy 5.
Effectiveness of Physiotherapy for Tendinopathy
- Studies have shown that physiotherapy can be effective in reducing pain and improving function in patients with tendinopathy 2, 3, 4, 5.
- Exercise therapy has been shown to be effective in improving outcomes for tendinopathy, including disability and physical function capacity 5.
- The effectiveness of physiotherapy for tendinopathy may depend on the type and location of the tendinopathy, as well as the specific exercise interventions used 5.
Considerations for Physiotherapy in Tendinopathy
- Physiotherapy for tendinopathy should be tailored to the individual patient's needs and goals, taking into account potential barriers to and facilitators of engaging with exercise 5.
- Patient education, self-management, and the patient-healthcare professional relationship are important factors to consider when prescribing exercise for tendinopathy 5.
- Further research is needed to fully understand the effectiveness of physiotherapy for tendinopathy and to inform best clinical practices 2, 3, 6, 5.