What Are the Best Strategies for Managing Chronic Tendonitis Without Steroid Injections?

April 5, 2024

Chronic tendonitis, commonly referred to as tendinopathy, is a condition that plagues many. From those engaged in relaxed sports to professional athletes, and even individuals who have taken a misstep or experienced an unfortunate fall, the pain experienced from this condition can be debilitating. There’s a growing trend towards avoiding steroid injections, which have long been the go-to for immediate relief, due to their potentially harmful long-term effects. As such, it’s crucial to explore alternative treatments. This article presents various strategies that have been supported by evidence and studies, for managing this nagging condition without resorting to steroid injections.

Understanding Chronic Tendinopathy

Before delving into the intricacies of tendinopathy treatment, it’s key to understand what this condition entails. Tendonitis or tendinopathy is a condition characterized by pain and inflammation of the tendons, the thick fibrous cords that attach muscle to bone. Commonly affected tendons include the Achilles and patellar tendons, although it can occur in any tendon in the body.

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Tendinopathy is often caused by repetitive or sudden, severe stress on the tendon, leading to micro-tears. Sports activities are a common culprit. Despite the term ‘itis’ implying inflammation, chronic tendinopathy isn’t always associated with inflammatory processes. In its chronic stages, it’s more of a degenerative condition than an inflammatory one. It’s therefore crucial that the treatment measures adopted address the underlying pathology and not just the symptoms.

Understanding this caveat is the first step towards managing chronic tendonitis more effectively.

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Physical Therapy for Tendonitis

Physical therapy is a key pillar in managing tendinopathy. In fact, its significance is underlined in numerous studies available on PubMed and other medical literature databases. One of the most effective physical therapy methods for managing tendinopathy is eccentric exercise.

Eccentric exercises involve the lengthening of the muscle-tendon unit while under load. Clinical studies have shown that eccentric exercises can induce structural changes in the tendon, improving its ability to withstand load and reduce pain. The Achilles and patellar tendons, two of the most commonly affected by tendinopathy, have both been shown to respond well to eccentric training.

While an individual can perform these exercises alone, guidance from a physical therapist is often recommended to ensure correct form and gradual progression, which is essential to avoid further injury.

Medication Management

Aside from physical therapy, certain medications can provide relief from tendinitis pain. However, it’s important to note that these shouldn’t replace therapy but rather, complement it.

Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used. These meds, while less potent than steroid injections, can provide symptomatic relief from the pain associated with tendonitis. They work by reducing inflammation and, therefore, pain. However, they should be used judiciously, as long-term use can lead to stomach issues and increased cardiovascular risk.

Topical analgesics like diclofenac gel can also be useful. They offer localized pain relief and have a lower risk profile compared to oral NSAIDs, making them a safer option for long-term use.

Dietary and Lifestyle Adjustments

As the saying goes, prevention is better than cure. With tendinopathy, certain lifestyle and dietary changes can go a long way in preventing flare-ups and promoting faster recovery.

Staying hydrated, eating a balanced diet rich in proteins (for tissue repair), and avoiding excessive strain on the tendons can help manage and prevent chronic tendonitis. Patients should also ensure they get adequate rest, especially if their activities involve repetitive tendon use.

The Role of Emerging Therapies

Emerging therapies such as Platelet-Rich Plasma (PRP) injections and Extracorporeal Shock Wave Therapy (ESWT) have shown promise in the treatment of chronic tendinopathy.

PRP therapy involves injecting a concentration of the patient’s own platelets into the affected tendon. These platelets release growth factors that promote tissue repair and regeneration. While more studies are needed to establish its efficacy fully, early evidence suggests it can be a viable alternative to steroid injections.

ESWT, on the other hand, uses sound waves to stimulate healing in the tendon. It’s a non-invasive treatment option that has been shown to reduce pain and improve function in chronic tendinopathy patients.

While more research is needed, these emerging therapies offer a glimmer of hope for those looking for non-steroidal alternatives in managing chronic tendonitis.

Focus on Specific Exercises and Sports Med Techniques

For those suffering from chronic tendinopathy, specific exercises can play a significant role in pain management and recovery. One area that has gained considerable attention in the sports med field is the use of eccentric strengthening exercises. This form of training focuses on the phase of muscle contraction when the muscle lengthens under tension, such as the downward motion in a bicep curl.

Eccentric exercises can stimulate the healing process within tendons, leading to improved strength and mobility. For instance, individuals dealing with patellar tendinopathy or Achilles tendinopathy can benefit greatly from exercises that target these specific tendons.

Besides eccentric exercises, isometric exercises, which involve holding a specific position without movement, can also aid in reducing pain. Studies on lateral epicondylitis, another form of tendinopathy affecting the elbow, have shown that isometric exercises can potentially decrease pain and increase grip strength.

Techniques such as stretching and foam rolling can also be beneficial in promoting tendon health. They can enhance flexibility, promote blood flow, and reduce muscle tightness, all of which can contribute to reducing the risk of tendon injuries.

In all of this, it is important to keep in mind that the guidance of a trained physical therapist can be invaluable. They can provide a tailored exercise regimen, monitor progress, and ensure that exercises are being performed correctly to avoid further harm.

Promising Results from Innovative Treatments

In recent years, innovative treatments such as Platelet-Rich Plasma (PRP) injections and Extracorporeal Shock Wave Therapy (ESWT) have emerged as potential non-steroidal interventions for managing chronic tendinopathy.

PRP therapy takes advantage of the body’s natural healing process. It involves isolating platelets from the patient’s blood and injecting them into the affected tendon. These platelets release growth factors that can stimulate tissue repair and regeneration. Several studies, some of which are available on PubMed, have presented promising results for PRP therapy in managing conditions such as Achilles tendon and rotator cuff tendinopathy.

Similarly, ESWT has been recognized for its potential in treating chronic tendonitis. This non-invasive procedure uses shock waves to promote healing and reduce pain. Several randomized controlled trials have shown significant improvements in pain and function following ESWT treatment.

While both PRP and ESWT show promise, more research is needed to fully understand their effectiveness and potential side effects. However, these treatments represent a potential shift away from reliance on corticosteroid injections and towards safer and possibly more effective alternatives.


In conclusion, managing chronic tendinopathy without resorting to steroid injections involves a multifaceted approach that includes physical therapy, medication management, dietary and lifestyle modifications, and potentially the integration of emerging therapies such as PRP and ESWT. It’s important to remember that each case of tendinopathy is unique and what works for one individual may not work for another. Therefore, a tailored approach under the guidance of healthcare professionals is essential. By staying informed about the latest research and seeking out effective alternatives to corticosteroids, it’s possible to manage chronic tendinopathy effectively and lead a pain-free, active life.