Tendinopathy is a chronic injury characterized by degeneration and a failed healing response, distinct from acute inflammation (tendinitis). This condition involves changes in the tendon’s internal structure, often stemming from repetitive overuse or a sudden increase in physical activity that overloads the tissue capacity. Effective recovery requires a structured approach, moving beyond simple rest to comprehensive rehabilitation that addresses these underlying structural changes.
Initial Steps for Symptom Relief
Managing the initial flare-up involves temporary adjustments to activity levels and the use of home remedies. This phase aims solely at reducing discomfort, not at healing the degenerative changes. Relative rest, meaning avoiding only the specific painful activities, is recommended for a short period (typically 2 to 3 days), as complete immobilization can be detrimental to long-term tendon health.
Applying ice for 15 to 20 minutes several times a day can help numb local pain and manage minor swelling. For chronic stiffness or prior to exercise, heat application can increase local blood flow and relax surrounding musculature. Over-the-counter medications, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), offer short-term symptomatic relief. Since chronic tendinopathy lacks significant inflammatory markers, NSAIDs do not actively repair the tendon structure. This temporary relief sets the stage for necessary long-term structural repair.
The Necessity of Controlled Loading and Rehabilitation
Long-term recovery requires controlled loading, a systematic, personalized exercise program designed to stimulate the tendon tissue. Complete rest is counterproductive because it decreases the tendon’s capacity to handle stress. The goal of therapeutic loading is to gradually increase the tendon’s strength and resilience by applying mechanical force.
A cornerstone of this approach is eccentric exercise, where the muscle-tendon unit lengthens while under tension (e.g., the lowering phase of a heel raise). This loading stimulates the production of collagen, the primary protein building block of the tendon matrix. The increased mechanical tension encourages the structural adaptation and reorganization of disarrayed collagen fibers within the injured tendon.
Effective rehabilitation protocols, such as the Alfredson protocol, involve high-repetition, twice-daily eccentric loading routines. Research also supports heavy-slow resistance (HSR) training, which incorporates both the shortening (concentric) and lengthening (eccentric) phases of movement with significant weight. HSR training, typically performed three times per week, is equally effective as isolated eccentric regimens and may promote better collagen turnover. A physical therapist is crucial for designing a personalized and progressive regimen, ensuring the load is appropriate and does not cause a pain flare-up lasting longer than 24 hours.
Advanced Medical and Procedural Treatments
When controlled loading fails to provide sufficient improvement after several months, advanced medical and procedural interventions may be considered. Corticosteroid injections provide rapid, short-term pain relief by reducing localized hypersensitivity. Caution is advised, as repeated injections can potentially weaken the tendon structure and increase the long-term risk of a tendon tear.
Platelet-Rich Plasma (PRP) therapy involves drawing the patient’s blood, concentrating the platelets and growth factors, and injecting the solution directly into the damaged tendon. PRP aims to introduce a high concentration of healing factors to encourage a regenerative response within the degenerative tissue. Another option is dry needling or tenotomy, where a fine needle is used under ultrasound guidance to make small punctures in the tendon. These micro-injuries trigger the body’s natural healing cascade.
ESWT and Surgical Options
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that delivers high-energy acoustic waves to the affected area. This mechanical energy creates microtrauma within the tendon, which helps restart the healing process and is useful for chronic cases that have stalled.
Surgery is reserved as a treatment of last resort for severe, refractory tendinopathy. It often involves the removal of the diseased tendon tissue, known as debridement.