Medical Treatment:
As stated in our last article, only paratenonitis (damage of the peripheral elements of the tendon, synovial sheaths, bursa) is real inflammatory damage, whereas tendinosis and enthesopathies consist in disorganizations of the fibrous tissues without inflammation.

Non-steroidal anti-inflammatory drugs (NAIDs), whether taken orally or applicated on the skin, should therefore only be taken, if necessary*, shortly (10 to 15 days) after the beginning of the affection, mainly for their pain killer effect. Applying “tissue gel” (Flector Tissugel or Voltapatch Tissugel) enables continuous diffusion of the product and gives better results. 
(* some studies wonder about the necessity of a natural inflammatory process for an optimal healing process).

The infiltrations of corticoids should only be considered for paratenonitis if the symptoms persist after the first treatments, because even if they do produce good enough results for the peripheral elements (bursa, synovial sheaths…), they weaken the tendon’s structure and disturb the enthesis’ healing. They should therefore be banned from those other kinds of injuries.

Osteopathic treatment :
It aimes at searching and eliminating the potential causes of tendinopathies, such as a lack of balance of the articulations or the muscle chains, sources of compensation which may lead to the overloading of a tendon. Some visceral dysfunctions can also lead to the appearance of tendinopathies. The osteopath will work on restoring the loss of balance.

Physical therapy treatment :

Firstly, the physical therapy treatment should include a local treatment to stimulate healing and/or tissue regeneration and favour indolence. All the therapeutic “tools” mentioned below should be used to achieve better results.

• Cryotherapy: analgesic and vascular functions
• Shock waves: stimulation of the healing, as well as analgesic and vascular effects
• Deep transverse massage (DTM): stimulation of the healing process, as well as analgesic and vascular effects
• Stanish protocol: progressive solicitation of the tendon with eccentric contractions at various angles and speeds associated to stretching exercises in order to stimulate a better reconstruction of the tendinous fibres.
• Other physiotherapies: ultrasound, cupping glass, hooking, electrotherapy… for their own effects.

Rest :
A strict rest doesn’t contribute to a good recovery, however, in case of tendinopathy, you must refrain from taking up training again (soliciting the injured area) too early. Cardiovascular upkeep by swimming, cycling, running, if there are no contraindications in relation to these activities (involving the injured area), will favour the return to training within the shortest delay.

Conclusion
The joint action of all actors responsible for the treatment of sportsmen and sportswomen will favour the return to training within the shortest delay. The earliness of general care will limit the shift to chronicity.
Therefore, as soon as pain appears, see a sports doctor.

In the next articles, we will cover the aspects of nutrition and of going back to training after a tendinopathy.

References :

BRUCHARD A., DUEE T. : Les lésions tendineuses : démarche thérapeutique. Profession Kinésithérapeute n°20, 2008.
CHANUSSOT J.C., DANOWSKY R.G. : Traumatologie du sport, Ed. Masson, 5ème éd., Paris, 1999.