Part II: Approach to tendon treatment

Tendonitis treatment approach:

The most prominent treatment goal for tendinitis is to reduce inflammation. Inflammation from acute tendonitis often responds quickly to anti-inflammatory medications (NSAID’s) and the PRICE* guidelines (1). Activities that re-create the symptoms should be avoided until pain settles. A comprehensive rehabilitation programme must also be commenced so the athlete can return back to full activity.

• -P-Protection
• -R-Rest
• -I- Ice
• -C-Compression
• -E- Elevation

1. Reactive tendinopathy/early tendon dysrepair: At this stage, load management (reduction) will generally allow the tendon time to adapt and cells to become less reactive. Also, a tendon with reduced load is likely to have less pain associated and allowing a day or two between high or very high tendon loads will facilitate the process (3). Assessment and modification of the intensity, duration, frequency and type of load is the key clinical intervention. This may also include identifying the potential for biomechanical overload (4).

Tendon load without energy storage and release, such as cycling or strength-based weight training, can be maintained, as this is less likely to induce further tendon response. Conversely, high load elastic or eccentric loading, particularly with little recovery time (eg, on successive days), will tend to aggravate tendons in this stage.

Non-steroidal anti-inflammatory medications (NSAIDs) have been reported to interfere with soft tissue healing in a range of tissues. Although pain may be reduced, they have a negative effect on tendon repair and are best avoided (2, 5-8).

2. Late tendon dysrepair/degenerative tendinopathy

At this stage, treatment should aim to stimulate cellular activity, increase protein production (collagen or ground substances) and restructure the matrix.

Exercise, particularly eccentric loading, has been shown to improve tendon structure (9) and manage pain (10-11) both in the short (12) and long term (13), allowing better function and return to activity.

Other modalities such as Shock Wave Therapy, Ultrasound and Friction were found clinically less effective in reducing pain than exercise (14,15,16). Pharmacological agents such as Prolotherapy (including blood), aprotinin, sclerosing therapy and glyceryl trinitrate have show variable inconsistent results (17-29). Surgery is only considered when patients have failed conservative interventions.

Tendinosis:

Treatment goals for tendinosis are similar to those of degenerative tendinopathy and aim to break the cycle of injury; optimizing collagen production and maturation so that the tendon regains normal tensile strength is key(30).

If you are having tendon symptoms professional assessment is advised in order to direct you towards the most effective treatment and identify factors that may predispose the current state of your tendon

See also:

Part I: Tendonitis vs Tendinopathy – The difference!
Part III: Taking care of your tendons
Running Related Injuries (RRI’s)
Ankle Injuries

References

http://emedicine.medscape.com/article/809692-treatment
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