Treatment of tendinopathy: what works, what does not, and what is on the horizon
Four articles on PainSci cite Andres 2008: 1. The Complete Guide to IT Band Syndrome 2. Complete Guide to Plantar Fasciitis 3. Tennis Elbow Guide 4. Guide to Repetitive Strain Injuries
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions. Thus, traditional treatment modalities aimed at controlling inflammation such as corticosteroid injections and nonsteroidal antiinflammatory medications (NSAIDS) may not be the most effective options. We performed a systematic review of the literature to determine the best treatment options for tendinopathy. We evaluated the effectiveness of NSAIDS, corticosteroid injections, exercise-based physical therapy, physical therapy modalities, shock wave therapy, sclerotherapy, nitric oxide patches, surgery, growth factors, and stem cell treatment. NSAIDS and corticosteroids appear to provide pain relief in the short term, but their effectiveness in the long term has not been demonstrated. We identified inconsistent results with shock wave therapy and physical therapy modalities such as ultrasound, iontophoresis and low-level laser therapy. Current data support the use of eccentric strengthening protocols, sclerotherapy, and nitric oxide patches, but larger, multicenter trials are needed to confirm the early results with these treatments. Preliminary work with growth factors and stem cells is promising, but further study is required in these fields. Surgery remains the last option due to the morbidity and inconsistent outcomes. The ideal treatment for tendinopathy remains unclear.
related content
- “Overuse tendinosis, not tendinitis, part 1: a new paradigm for a difficult clinical problem (part 1),” Khan et al, Phys Sportsmed, 2000.
- “Overuse tendinosis, not tendinitis, part 2: applying the new approach to patellar tendinopathy,” Cook et al, Phys Sportsmed, 2000.
- “Histopathology of common tendinopathies. Update and implications for clinical management,” Khan et al, Sports Medicine, 1999.
- “Plantar fasciitis: a degenerative process (fasciosis) without inflammation,” Lemont et al, Journal of the American Podiatric Medical Association, 2003.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
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