Evidence-Based Fitness: What Works & What Doesn’t for Treating Tendon Strains?

Evidence-Based Fitness: What Works & What Doesn’t for Treating Tendon Strains?

(Last Updated On: September 29, 2019)

tendon strains

Tendon strains are referred to in the healthcare world as tendinopathies. This term refers to any type of tear or inflammation involving the thick fibrous bands known as tendons. You may have heard tendon strains called tendonitis or tendinosis. Tendinopathy refers to both types of injury. Tendonitis is the inflammation of a tendon whereas tendinosis refers to small microtears that develop when a tendon is overused. Most tendon strains are tendinosis rather than tendonitis, although many healthcare professionals still use the term tendonitis to describe both entities.

Tendinopathies are among the most common sports-related injuries. Some are due to an acute injury that happens while playing a sport, lifting weights, or running, but the majority are overuse injuries. They come from repetitive stress on a tendon without giving the tissue a chance to recover.

In many cases, a minor tendon injury or tendinopathy will heal without treatment, although it can take weeks or months for healing to occur. Even then, the risk of reinjuring the tendon is high. Sometimes, all you need is to modify your training in a way that takes the stress off the injured tendon. This doesn’t always mean you have to stop exercising, but you need to alter your training and avoid doing anything that causes pain.

What about tendinopathies that linger or don’t get better over time? What works for treating tendon strains and tendinopathy? An article in American Family Physician looks at what treatments have the most evidence for healing tendon strains.

Cryotherapy For Tendon Strains

Cryotherapy is applying cold to an injured muscle or tendon. Most practitioners recommend placing cold on the injured area for 10 minutes at a time several times per day. Some people use gel packs, but there’s stronger evidence for the effectiveness of applying ice cubes wrapped in a wet towel. Overall, there is moderately strong evidence that cryotherapy is effective for managing tendinopathies, although it’s not clear how it works. One theory is that cold application slows cellular metabolism in the area and reduces blood flow. The reduction in metabolism and blood flow may reduce the release of inflammatory molecules that trigger the pain.

Eccentric Strength Training For Tendon Strains

Another treatment backed by science is eccentric strength training. As you know, eccentric exercises involve lengthening a muscle while it’s loaded with weight. For example, the lengthening phase of a biceps curl. How does it work? Eccentric training may alter the structure of the tendon in a way that reverses the micro-tears and degenerative changes that are characteristic of tendinosis. In one study, eccentric strength training for Achilles tendinopathy resulted in a 60% reduction in pain while the control group experienced only a 33% pain reduction.

It’s best to work with a physical therapist who can design an eccentric program to help tendinopathy heal. Most physical therapists recommend 3-4 sets of eccentric exercises for the affected tendon daily for at least 3 months. They usually prescribe lighter weights and performing between 12 and 15 slow reps for each set.

Anti-Inflammatory Medications

If you visit your doctor with tendinopathy, there’s a good chance you’ll end up with a prescription for non-steroidal anti-inflammatory medications or they’ll tell you to take ibuprofen. However, these medications are designed to relieve inflammation and tendinosis is a degenerative process characterized by small micro-tears. Therefore, a NSAID may have little benefit. In fact, there’s some evidence that NSAID may delay the healing of tendon damage. Where NSAID may be more effective is with true tendonitis since there’s active inflammation. However, NSAID have other potentially serious side effects. Always use them with caution and after discussing the pros and cons with your physician.

When tendinopathy lingers, some health care professionals recommend injecting a corticosteroid into the tendon. Corticosteroids reduce inflammation, but tendinosis is not an inflammatory process in the same way tendinitis is. Still, people often experience short-term relief after such an injection. However, research suggests it doesn’t alter the long-term healing process. Another problem is repeated injections can damage the tendon, so it’s something to avoid if possible. Most practitioners recommend injecting corticosteroids only in cases of rotator cuff tendinopathy, so it’s not always an appropriate treatment.

Extracorporeal Shock Wave Therapy

Another therapy that has moderate scientific support behind it is extracorporeal shock wave therapy, also known as orthotripsy. This procedure delivers shock waves to injured tendons, similar to the manner that shock waves are used to break up kidney stones. Studies show it can reduce the pain of a variety of musculoskeletal and tendon conditions, including tendinopathies and plantar fasciitis. It may also aid in healing an injured tendon by increasing the formation of new blood vessels around the injured tendon.

The advantage of extracorporeal shock wave therapy is it takes only takes 20 minutes and is noninvasive. The downsides are it’s expensive and the procedure itself can be uncomfortable. Plus, you will probably need several treatments.  However, studies show it can ease tendon pain in people with tendinopathy and may promote healing. Since it’s expensive, extracorporeal shock wave therapy is best for chronic cases that don’t respond to conservative therapy within 6 months.

Other Therapies

Other, more advanced therapies have less evidence behind them, although they may ultimately prove to be beneficial when other therapies are ineffective. These include such treatments as low-level laser therapy, iontophoresis, platelet-rich plasma therapy, and phonophoresis. Chronic tendinopathies may also respond to surgery, including minimally invasive surgery, although it’s best to avoid surgery if other treatments can help.

The Bottom Line

If you have chronic tendinopathy, a sports medicine doctor and a physical therapist can work with you to determine the best course of action. In many cases, cryotherapy and eccentric strength training will be enough to help your tendons heal without the downsides of more expensive and invasive therapies. Be sure to modify your training to avoid worsening the pain, and be patient, tendinopathies are slow to heal!



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·        J Can Chiropr Assoc. 2011 Dec; 55(4): 269–279.

·        Int J Sports Phys Ther. 2015 Aug; 10(4): 552–562.

·        Br J Sports Med. 2005 Dec; 39(12):912-6.

·        Clin. J. Sport Med. 2006; 16: 1–3.

·        Clin Orthop Relat Res. 2008 Jul;466(7):1539-54. doi: 10.1007/s11999-008-0260-1. Epub 2008 Apr 30.

·        Am Fam Physician. 2013 Apr 1;87(7):486-90.


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