A number of rehabilitation and physiotherapy interventions are widely used in the treatment of tendinopathy.
- The use of cryotherapy on an acute tendon injury is a common practice. However, as with many of the therapies used, few studies have analysed their real utility from a scientific perspective. It is believed that cold reduces the blood flow in the tissue, pain, nerve conduction speed, the metabolic rate of the tendon and therefore, the oedema and inflammation of an acute injury. The main benefit is postulated to be analgesia, which might justify its popularity.
- Like cryotherapy, this is the other commonly used treatment in tendon pathologies. It is traditionally divided into two categories: superficial and deep. Superficial includes hot packs, infrared lamps, whirlpools, paraffin baths and fluidotherapy. Deep heat includes ultrasound and diathermy. While both ultrasound and diathermy are widely used, there is little scientific evidence to justify their use.10
- Manual therapy
- Some manual therapies are popular in the treatment of tendon injuries. The two most common are deep transverse massage (popularised by Cyriax) and soft tissue mobilisation.10
Deep transverse massage has been the subject of revision by Cochrane. Only two randomised studies have been found of sufficient quality for inclusion, one in the treatment of tendinopathies of the extensor carpi radialis (epicondylitis) and the other in the treatment of the iliotibial band friction syndrome. In neither of these did deep transverse massage show any benefit for the control group with respect to pain, force or functionality, although the conclusions were limited by the small size of the sample.10
Soft tissue mobilisation consists of mobilisation by massage of the area around the tendon to stimulate a contribution of blood to the area around the injury, thus helping to heal the tendon.
- Extracorporeal shock waves
- The use of extracorporeal shock waves has become more common in recent years, particularly in calcifying tendinopathies. Recently, it has been demonstrated that, in the treatment of Achilles tendinopathy, the combination of eccentric exercise and repeated low energy shock wave treatment is more effective than isolated eccentric exercise.
- Hydrokinesitherapy is advocated for non-load-bearing training. At present, the use of swimming pools for such exercise is being displaced by anti-gravity treadmills as they are cheaper, more hygienic, easier to maintain and adaptable to any sports facility or treatment. These are treadmills that can reduce body weight by up to 80% through the creation of a sealed compartment. This enables non-load-bearing exercise from very early phases during rehabilitation through to high-intensity training, thus minimising articular load.
- Some clinicians advocate the use of low intensity “cold” laser in the treatment of tendinopathies. However, the results are contradictory and therefore laser cannot be recommended until new evidence clarifies its role.
Dr Ricard Pruna
Sport and Exercise Medicine