From the Guidelines
Tendinosis treatment should prioritize relative rest, eccentric strengthening exercises, and gradual return to activity, as these approaches have been shown to promote healing and pain relief 1. The initial step in managing tendinosis involves reducing activities that aggravate the affected tendon, as recommended by the American Family Physician in 2005 1.
Key Recommendations
- Reduce activity to decrease repetitive loading of the damaged tendon, as this is a crucial step in preventing further damage and promoting healing 1.
- Apply ice for 15-20 minutes several times daily to manage pain, as cryotherapy provides acute relief of tendinopathy pain 1.
- Use over-the-counter pain medications like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily) for short-term pain relief, but note that they have no effect on long-term outcomes 1.
- Engage in physical therapy, focusing on eccentric strengthening exercises where the muscle lengthens while contracting, performed 3 sets of 15 repetitions twice daily for 12 weeks, as this approach has been shown to be effective in treating tendinopathy 1.
Additional Considerations
- For persistent cases, consider platelet-rich plasma injections, but avoid corticosteroid injections as they can weaken tendons 1.
- Surgery may be an effective option in carefully selected patients who have failed three to six months of conservative therapy, as it can promote healing by excising abnormal tendon tissue and releasing areas of scarring and fibrosis 1.
- Gradually return to normal activities only when pain-free, increasing intensity by no more than 10% weekly to prevent recurrence, as tendons have limited blood supply, making healing slow 1.
From the Research
Treatment Options for Tendinosis
- Eccentric exercise has the strongest evidence of efficacy in treating tendinosis, as shown in studies 2, 3, 4, 5
- Extracorporal shock wave treatment has mixed evidence and needs further study of energy and application protocols 2, 3
- Sclerosing agents show promising early results but require long-term studies 2
- Corticosteroid and nonsteroidal anti-inflammatory medications have not been shown to be effective, and many basic science studies raise possible concerns with their use 2, 6
- Nitric oxide has been shown in several basic science studies to be promising, but clinical efficacy has not been well established 2, 6
- Platelet-rich plasma injections have offered encouraging short-term results, but larger and longer-term clinical trials are needed to assess this promising modality 2, 3, 6
- Matrix metalloproteinase inhibitors have had few clinical studies, and their role in the treatment of tendinosis is still in the early phase of investigation 2
Rehabilitation and Management
- Early initiation of rehabilitative exercises that emphasize eccentric loading is beneficial in treating tendinosis 4, 5, 6
- Activity modification, relative rest, pain control, and protection are the mainstays of treatment for tendinosis 6
- Cryotherapy has a role in controlling pain, despite a lack of high-quality evidence 6
- Nonsteroidal anti-inflammatory drugs and corticosteroids have a role in treatment, despite the lack of histologic evidence of inflammation, but care should be taken when injecting corticosteroids into and near major load-bearing tendons due to the risk of rupture 6