Treatment for Tendinosis

Understanding Tendinosis

Tendinosis is a degenerative condition of tendons characterized by collagen disorientation and fiber separation, not acute inflammation as previously thought 3
Most cases represent chronic tendinosis rather than acute inflammatory tendinitis, as patients typically present after prolonged symptoms when acute inflammation has subsided 3

Eccentric strengthening exercises are highly effective for treating tendinopathy and may reverse degenerative changes 2, 3
Deep transverse friction massage is recommended to reduce pain in tendinopathies 1, 2
Relative rest to decrease repetitive loading of the damaged tendon is essential, but complete immobilization should be avoided 2, 3

Cryotherapy (ice application) provides effective short-term pain relief, with the most effective method being applications through a wet towel for 10-minute periods 4, 2
NSAIDs effectively relieve tendinopathy pain in the short term but do not alter long-term outcomes 4
Topical NSAIDs can reduce tendon pain with fewer systemic side effects compared to oral NSAIDs 4, 2

Corticosteroid injections may be more effective than NSAIDs for relief in the acute phase but do not alter long-term outcomes 1, 4
Caution is advised with corticosteroid injections as they may inhibit healing and reduce tendon tensile strength, potentially predisposing to rupture 4
Corticosteroid iontophoresis can be effective for treatment of patellar tendinosis pain and function 1, 3

Orthotics and braces can be valuable adjuncts to reinforce, unload, and protect tendons during activity 4
Shoe orthotics may be beneficial for Achilles tendinopathy to correct overpronation or pes planus problems 1
Heel lift orthotics can unload the Achilles tendon for pain relief 1

Extracorporeal shock wave therapy (ESWT) appears to be safe and may be effective, though studies show mixed results 1, 4, 3
Therapeutic ultrasonography may decrease pain and increase collagen synthesis, but evidence for consistent benefit is weak 4
Iontophoresis and phonophoresis are widely used but lack strong evidence from randomized controlled trials 4

Surgery should be considered only if conservative measures fail after three to six months of consistent treatment 4, 2
Approximately 80% of patients with tendinopathies fully recover with conservative management within three to six months 2

Activities requiring repetitive wrist extension contribute to lateral epicondylosis (tennis elbow) 1
Orthotics are commonly used for lateral epicondylosis, though evidence for their effectiveness is limited 1
Patellar tendinopathy is particularly common in jumping athletes and causes activity-related anterior knee pain 1, 3
Pain is typically exacerbated by navigating stairs and prolonged sitting 1, 3
The decline squat test often reproduces a patient's pain and can be used diagnostically 1
Achilles tendinopathy is common among adult runners with increasing incidence with age 1
Etiology is often multifactorial (improper technique, anatomic misalignment, weakness, uneven training surfaces, improper footwear) 1
Physical examination often reveals thickening and tender, palpable nodules 1

Misdiagnosing tendinopathy as an inflammatory condition ("tendinitis") rather than a degenerative condition ("tendinosis") can lead to inappropriate treatment focus 2
Failure to address underlying biomechanical issues or technique problems may lead to recurrence 2
Corticosteroid injections should be used with caution as they may provide short-term relief but potentially cause long-term harm 4