The challenge of treating tendinitis is that there’s not always the inflammatory component that the name suggests. As a result, the injury does not always respond to traditional anti-inflammatory treatments. Fortunately, there are many treatment options availableAlthough ice and a short course of anti-inflammatory medication can provide short-term symptom relief, the core of treatment consists of rest, rehabilitation, and the correction of aggravating factors.
In order to allow the injured tendon the necessary time to heal, it’s important to rest the affected area. However, rest does not mean complete inactivity. Instead, you should employ “relative rest,” or avoiding symptom-provoking activities.
One of the best-studied treatment options is to perform eccentric exercises, which involve gently stressing the tendon while it’s being lengthened. This helps stimulate the injured tendon to remodel to a more normal state. The exercises should be performed in a slow, controlled manner, with a progressive increase in the amount of stress applied.
It’s also important to not just treat the symptoms, but also identify the cause. Simple adjustments to your training regimen (such as adding cross-training or avoiding rapid increases in distance and sudden changes in type of training surface) or corrections of any biomechanical abnormalities that place your tendon at increased stress can both improve your symptoms and help prevent them from returning.
Numerous other treatment options currently under investigation can potentially supplement your treatment. Topical nitroglycerin patches; injections of platelet-rich plasma; prolotherapy; sclerotherapy; dry needling; and extracorporeal shock-wave therapy have all been studied, with varying degrees of success. Further research is needed to understand how best to use these therapies, but they may be worth discussing with your physician if you haven’t found success with other treatments.
Dr. David A. Wang is a sports medicine physician at Hospital for Special Surgery specializing in the treatment of acute and overuse injuries. His main clinical and research interests are overuse injuries, concussion, viscosupplementation injections, and the pre-participation physical exam. As a former collegiate baseball player, he also has a special interest in the care of baseball players.