Conservative management of tendinopathy: an evidence-based approach

Tendinopathy is one of the most frequent overuse in- juries associated with sport. It is a failure of a chronic healing response associated with both chronic over- loaded and unloaded states. Although several conser- vative therapeutic options have been proposed, very few of them are supported by randomized controlled trials. Eccentric exercises provide excellent clinical re- sults both in athletic and sedentary patients, with no reported adverse effects. Combining eccentric loading and low-energy shock wave therapy produces higher success rates compared with eccentric training alone or shock wave therapy alone. High-volume injection of normal saline solution, corticosteroids, or anesthetics can reduce pain and improve long-term function in pa- tients with Achilles or patellar tendinopathy. The use of injectable substances such as platelet-rich plasma, autologous blood, polidocanol, and corticosteroids in and around tendons is not support by strong clinical evidence. Further randomized controlled trials are nec- essary to define the best conservative management of tendinopathy.