Tendonitis

Rest initially (acute tendonitis—2-7 days rest from aggravating activity, relative rest not complete immobilization), Ice: acute phase only (first 2-3 days—ice 15-20 min every 2-3 hours reduces acute inflammation), after acute phase: heat or contrast therapy (improves blood flow, promotes healing), Eccentric exercises MOST IMPORTANT (for chronic tendinosis): eccentric strengthening (slowly lowering phase—proven most effective for tendon healing, stimulates collagen remodeling, Alfredson protocol for Achilles tendinosis—3x15 reps twice daily, heavy slow resistance training effective, initially may increase pain—normal healing response, work with physical therapist to learn proper technique), Activity modification: avoid repetitive movements that caused tendonitis, gradual return to activity (don't increase >10% per week), cross-training (maintain fitness without stressing injured tendon), Biomechanical assessment: physical therapy evaluation to identify poor movement patterns, muscle imbalances, weakness (address root cause), proper technique in sports/work activities, Stretching: maintain flexibility of muscle-tendon unit (tight muscles increase tendon stress), but aggressive stretching may worsen acute tendonitis—gentle stretching after acute phase, Strengthening: address muscle weakness (weak muscles overload tendons), gradual progressive loading, Bracing/taping: short-term use to offload tendon during healing (tennis elbow strap, patellar tendon strap, wrist brace), but don't rely long-term—address root cause, Massage: cross-friction massage (stimulates healing, breaks down adhesions—performed by physical therapist or massage therapist), self-massage with foam roller or massage ball, Avoid: corticosteroid injections (weaken tendons—increase rupture risk by 30-50%, may provide short-term relief but worsen tendon degeneration long-term, multiple injections very risky, some evidence single injection acceptable for acute severe tendonitis if other treatments failed, but avoid in chronic tendinosis), NSAIDs chronic use (impair tendon healing—short-term use for acute pain acceptable, but long-term use reduces collagen synthesis, delays healing), complete immobilization (leads to tendon atrophy and stiffness—relative rest with gentle movement preferred), Regenerative treatments for chronic tendinosis (failed 3-6 months conservative treatment): PRP (Platelet-Rich Plasma) injection—stimulates healing, 60-80% success rate for chronic tendinosis, evidence strongest for tennis elbow, Achilles, patellar tendinosis, expensive ($500-1500), 1-3 injections, Prolotherapy—dextrose injections stimulate healing response, multiple injections needed (3-6), cheaper than PRP, evidence moderate, Surgery: last resort for chronic tendinosis after 12+ months conservative treatment fails or acute tendon rupture—debridement of degenerated tissue, tendon repair if ruptured, long recovery 3-6 months, risks (infection, nerve damage, rupture, scar tissue), Common sites: Achilles tendonitis (heel pain, calf pain—eccentric heel drops proven effective), Tennis elbow (lateral elbow pain—eccentric wrist extension exercises), Golfer's elbow (medial elbow pain—eccentric wrist flexion), Rotator cuff tendonitis (shoulder pain—physical therapy, avoid overhead activities), Patellar tendonitis (jumper's knee—eccentric squats), De Quervain's tenosynovitis (thumb side wrist pain—splinting, avoid thumb use), Most tendonitis/tendinosis resolves with: proper diagnosis (tendonitis vs tendinosis), activity modification, eccentric strengthening exercises, addressing biomechanical factors, anti-inflammatory diet and supplements, patience (healing takes 3-6 months)—surgery rarely necessary.