Tendonitis - Treatment 

Treating tendonitis 

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More evidence needed

Few of the recommended therapies for tendonitis have been subjected to randomised controlled trials (RCTs), and a stronger evidence base is needed before particular treatments can be classed as being totally effective.

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for tendonitis

An episode of tendonitis may only last for a few days. However, sometimes it can be more persistent and last for several weeks or months.

There are a number of different treatment options, although what's best for you may depend on which tendon you have injured.

Self-care

You can treat tendonitis yourself at home using the self-care techniques described below.

Rest the tendon

Stop doing the activity that caused tendonitis, such as sport or typing, or at least reduce the amount you do. This will help prevent any further inflammation or damage.

It's important to rest the affected area to allow the inflammation to settle. Some form of support, such as a bandage, splint or brace, may help by reducing movement.

How long you need to rest for may depend on which tendon is affected and how severely it is damaged. For example, if you have golfer's elbow, you may need to rest your elbow for at least six weeks.

Ice packs

Applying an ice pack to the affected area may help ease the pain and swelling. Do not put ice directly on your skin, as it may cause a cold burn. Instead, wrap it in a towel or put a towel over the injured area before applying the ice pack. A bag of ice cubes or frozen vegetables wrapped in a towel works just as well.

Hold the ice pack on the affected area for around 15-20 minutes several times a day. You can also use an ice pack after exercise to try to prevent symptoms occurring.

Painkillers

Tendonitis can be treated with mild non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. NSAIDs provide short-term pain relief and help reduce inflammation. They are available as a medicine that you swallow or as a gel that you apply directly to the affected area. 

These drugs should not be used for long periods and are not recommended for people with asthma, kidney disease or liver disease

Other painkillers, such as paracetamol, will also help ease the pain. For more severe pain, a stronger painkiller such as codeine can be prescribed.

Dietary supplements

Some people have reported that their tendonitis symptoms improved after taking dietary supplements such as amino acids. However, as yet there is no scientific evidence to show that these supplements have any benefits.

Therapies and injections

Physiotherapy 

Physiotherapy uses massage and manipulation to help recover movement and function in the affected areas. There are many different physiotherapy techniques, including:

  • special exercises to stretch and strengthen the tendon and surrounding muscles
  • massaging the affected area
  • high-frequency sound waves (ultrasound)
  • narrow beams of light (lasers)

Physiotherapy can be used to relieve pain and may result in more long-term improvement than corticosteroid injections.

Corticosteroid injections

Corticosteroids are medicines that contain steroids (a type of hormone) and can be used to reduce inflammation. If there is inflammation, corticosteroids can be injected around the affected tendon or into the tendon sheath.

Although corticosteroid injections can relieve pain, they do not have a long-term effect and the pain often returns. You can have another injection, but you will need to wait at least six weeks.

It is not possible to have more than three injections into the same area in a year, as it can increase the risk of the tendon rupturing (splitting).

Corticosteroid injections may have side effects such as thinning and lightening of the skin.

Local anaesthetic injections

Local anaesthetic is often used to numb a specific area of the body during minor surgical procedures. In some types of tendonitis, local anaesthetic can be injected into the affected area as well as corticosteroids.

Extracorporeal shock wave therapy

Extracorporeal shock wave therapy (ESWT) is a treatment option when tendonitis has not responded to other treatments.

It involves passing shock waves through your skin to the affected area. This may be carried out over one or more sessions, and local anaesthetic may be used to numb the area first.   

The treatment may help relieve the pain caused by tennis elbow or Achilles tendonitis, but it is not clear whether it is better than other treatment options.

If you are considering this treatment, you may be asked to take part in a clinical trial to look at how effective it is over time.

There are also possible risks, such as:

  • the tendon rupturing – in one study, this happened to two out of 49 people who had ESWT for Achilles tendonitis 
  • temporary redness or swelling
  • pain during the treatment
  • feeling sick

The National Institute for Health and Care Excellence (NICE) has produced guidelines about the use of:

Surgery

Surgery may be a possible option for some types of tendonitis. However, most cases of tendonitis improve with time, so surgery is not usually necessary. You may want to try other treatments for up to a year before considering surgery.

Tennis elbow

Several different surgical techniques have been used for tennis elbow, including:

  • removing a damaged section of muscle from the elbow
  • removing part of a ligament in your elbow
  • damaging a nerve in your elbow so you no longer feel pain there

The benefits of surgery for tennis elbow have yet to be proven. Your symptoms may improve, but this could be because the condition was getting better anyway, or it may be as a result of the placebo effect.

After surgery, you should be able to start playing sport again within four to six months.

Calcific tendonitis

Surgery can be used to remove calcium deposits that have formed in the tendon in your shoulder. This can be carried out using a technique called an arthroscopy.

An arthroscopy is a type of keyhole surgery that can be used to look inside a joint and repair any damage. Only a very small cut needs to be made in your body.

Biceps tendonitis

Biceps tendonitis affects the tendon that attaches the muscle on the front of your upper arm (bicep) to your shoulder.

Surgery can be used to reattach the end of the tendon to the bone in your upper arm (humerus). This may be an option if you are in severe pain or you have torn the tendon.

Page last reviewed: 10/04/2013

Next review due: 10/04/2015

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Comments

The 9 comments posted are personal views. Any information they give has not been checked and may not be accurate.

tomlad78 said on 26 September 2014

How many multi aminos tablets would you take per day for patella tendonitis?

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paddycoogs said on 25 June 2014

Trickie Man - If you have not opted for surgery yet I would seriously urge you to reconsider or enter into it with caution.

Your symptoms and frustrations are all too familiar, and I myself opted for surgery (decompression of tendon and shaving of patella)...it was unsuccessful, and to be honest it gives me more grief than it did before.

My advice...persevere. There is a lot of science coming out to support adapted strength programmes and that promote activity over rest (within a certain pain threshold).

I wish you all the best. It is an extremely frustrating conditions that hinders me every day, but it is about managing the pain and your expectations. It's as much a psychologically damaging condition as it is a physiological one.

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Trickier man said on 25 January 2014

I have had patella tendinitis for two years now and waiting for 2nd PRP injection. Really disappointed in length of time this has taken to resolve. I am unable to do sport and have pain every day doing things like walking up and down stairs etc. can't even sit for too long or drive a car due to excessive pain. I hide it from work to get by and in that two years I've had an MRI, physio, 2/3 steroid injections, blood tests, PRP, a Lot of the delays have been down to cancelled or wasted appointments by the Nhs. I feel like it is so bad surgery is the only option but they seem to want to avoid that at all costs which for me I just want a resolution and be able to be active again and live my life without daily pain.

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devonguy said on 26 August 2013

Suddenly woke up one day unable to put any weight on my right leg due to extreme pain in the heel. Doctor diagnosed tendonitis at the back/base of the heel suggested I took Ibuprofen to ease pain. Next day whole foot had swelled to twice its normal size and absolute agony to touch the back or base of the heel. Visited casualty where it was again diagnosed as Achilles tendonitis and I was told healing would be a long & painful process of up to six months or more. Gave me a special boot to angle the foot and take the weight off the heel and a set of crutched. A week later the swelling got even worse and my GP sent me to the Fracture Clinic were it was again diagnosed as Achilles tendonitis (not a break). After about four weeks of keeping the foot elevated, taking Ibuprofen, and using ice packs there was still no improvement. Told by Physiotherapist that despite the pain I had to start putting weight on the heel in order to promote circulation and heeling. He said no matter how long I left it to get better on its own, unless used, it simply would not heal on its own accord. So I started to bear as must weight as possible on the foot whilst using the special boot and crutched. I also read up on what others had said and started to take low doses of amino acids and also bought a Revitive machine to try to increase blood flow to in order to aid healing. Used the machine with Ibuprofen gel twice a day together with weight bearing/walking around the house using the special boot.. This really reduced the swelling and after seven weeks the foot is almost normal size. I am now able to walk using normal boots short distances provided I insert a gel wedge under the heal (to avoid over stretching the muscle/tendon. I seem well on the road to recovery and from experience would suggest that if healing is slow then Ibuprofen, amino acids and the Revitive machine (or similar) are well worth a try. Good luck




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michele cornwall said on 21 February 2013

After struggling for months with tendonitis in my upper arm, i searched the internet for help,i read the second comment above from arleeson. I decided to give the amino acid tablets a go.I cant beleive the difference in my movement and reduction in pain. If this result carries on i will not be having surgery.I have read numerous reports and side effects of these tablets as far as i can see very little they even say they can give you a healthy state of mind, that may be because i feel so much better, they have to be worth a try.Thanks again arleeson proves a problem shared is a problem halved.

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kerrol said on 09 August 2012

I am a 66 yr old female and have been in pain with calcific tendonits for over a year - a Chiropractor administered / massage / and ultrasonic with absolutely no change -steroid injection helped for a while I was beginning to think I just had to live with the pain - surgery was the next step - however I read your article about amino acid tablets / vit E and thought I,d a go - wow I cannot believe the improvement after just one week - sleep is not so painful- movement is a little more comfortable I am going to continue for a month and am full of hope - Thank you

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NE1L said on 18 July 2012

TREATMENT SUGGESTION...

I (male mid-thirties tennis player) had tendonitis diagnosed in my shoulder and had some quarterzone (excuse spelling), which help for a brief period, discussion then moved onto scheduling an operation which I was not keen on and so said I would be in touch in a few weeks.

I then did some research on the internet, following which I took some Multi Amino Acid tablets and Vitamin E tablets, which resolved the issue completely in 2 weeks, Amino Acids are used by body builders as it is an essential ingredient/nutrition when muscle tissue rebuilds itself stronger after exercise.
These supplements are available in high street health shops (such as Holland & Barrett).

Amino Acids are naturally in certain foods types for example eggs.

I would recommend this for men and women alike, unless your calorie intake is very high and you are also exercising vigourously you wont increase muscle size noticeably.

Hope this is of help, it helped me make a complete recovery and meant surgery was not required. It may not be of help to everyones condition but its certainly worth trying. Take doses of supplements as detailed on packaging for a few weeks, following which I take the supplements once a week just to provide occaisional supplement supoport. Good luck let me know if this helps or not.

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arleeson said on 29 May 2012

@Baz5150
Has anyone ever suggested changing your diet? I went to an osteopath who had a background as a nutritionist and he was convinced it could make a difference and made some good suggestions. A doctor I visited, who had herself had tendonitis, told me that its a lack of lubrication in the tendon, so maybe things like cod-liver oil are good? I can't really remember but it may be worth visiting a nutritionist?

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Baz5150 said on 20 February 2012

I have been suffering with tendonitis in both my elbows now for over 2yrs. My treatments with the NHS have included Naproxen tablets and gel rubs which did nothing. I have steroid injections every 6mths and they did work for a while but no longer do since my last one was 3 weeks ago and did nothing whatsoever. My last visit was today and the Doctor gave me yet another tube of gel and another prescription for Naproxen even though i told him neither of these treatments worked. He also booked me for yet another steroid injection in 4wks time even though i told him that the injections have stopped working. I asked him if surgery was an option and he told me outright that there was no surgery available for Tendonitis, then i looked it up on here and apparantly it is an option. Can someone please help me regarding this matter?

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