In this second part different treatment modalities will be discussed for each tendon pathology.
Tendonitis Treatment Approach
The primary goal in treating tendinitis is to reduce inflammation. Acute tendinitis often responds well to anti-inflammatory medications (NSAIDs) and the PRICE* guidelines (1). Activities that trigger symptoms should be avoided until the pain subsides. Additionally, a comprehensive rehabilitation program should be initiated to help the athlete return to full activity.
- -P-Protection
- -R-Rest
- -I- Ice
- -C-Compression
- -E- Elevation
Tendinopathy Treatment Approach
In tendinopathy and tendinosis, inflammation is not present. In fact, anti-inflammatory treatments can be counterproductive for tendinosis (2). Therefore, these conditions are best treated with functional rehabilitation (31). Rehabilitation focuses on strengthening the muscles and tendons and addressing any biomechanical deficits. Re-evaluating training load is crucial when managing tendinopathies.
1. Reactive Tendinopathy/Early Tendon Dysrepair
At this stage, reducing the load on the tendon generally allows it time to adapt and become less reactive. This reduction can also decrease pain, and incorporating rest days between high tendon loads will aid the healing process (3). Key interventions include assessing and modifying the intensity, duration, frequency, and type of load, as well as identifying potential biomechanical overloads (4).
Activities that involve tendon load without energy storage and release, such as cycling or strength-based weight training, can usually be continued. However, high-load elastic or eccentric activities, especially with little recovery time, tend to aggravate the tendon at this stage.
NSAIDs are generally avoided because, while they may reduce pain, they can negatively impact tendon repair (2, 5-8).
2. Late Tendon Dysrepair/Degenerative Tendinopathy
In this stage, treatment aims to stimulate cellular activity, increase protein production (collagen or ground substances), and restructure the matrix. Eccentric loading exercises have been shown to improve tendon structure (9) and manage pain both in the short (12) and long term (13), enhancing function and facilitating a return to activity.
Other treatments like Shock Wave Therapy, Ultrasound, and Friction have been found to be less effective in reducing pain compared to exercise (14-16). Pharmacological agents such as Prolotherapy (including blood), aprotinin, sclerosing therapy, and glyceryl trinitrate have shown inconsistent results (17-29). Surgery is only considered when conservative treatments have failed.
Tendinosis Treatment Goals
The treatment goals for tendinosis are similar to those for degenerative tendinopathy. The aim is to break the cycle of injury and optimize collagen production and maturation, allowing the tendon to regain normal tensile strength (30).
Professional Assessment
If you are experiencing tendon symptoms, professional assessment is recommended to determine the most effective treatment and identify factors contributing to your condition.
See Also:
- Part I: Tendonitis vs Tendinopathy – The Difference!
- Part III: Taking Care of Your Tendons
- Running Related Injuries (RRIs)
- Ankle Injuries
References
http://emedicine.medscape.com/article/809692-treatment
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