Physiotherapy for Tendinopathy – What Treatment Works? Article of The Week #6

Every Monday you will find a top quality research study summarised for you here on Physiospot. The articles are chosen as they are high quality and high impact and likely to shape your clinical practice. After all it’s difficult finding the gems in all the research that’s published daily. So let us do the hard work for you.

Tendonopathy most comon affects the wrist flexors, wrist extensors, rotator cuff, patellar and achilled tendons. It is characterised by a clinical syndrome of pain, swelling and loss of function and it is theorised that is is caused by an abnormal healing response within the tendon itself, although this is often debated. The term tendinopathy is a generic descriptor of the clinical conditions ( both pain and pathological characteristics) associated with overuse in and around tendons.

Conservative treatment is the mainstay in tendinopathy treatment with ultrasound, laser therapy, shockwave and exercise being the main treatments of choice. The best treatment protocol for each of these treatment choices is poorly definied and there are lots of conflicting studies which exist many of which are modality specific not disease orientated. This causes further confusion as although histological studies confirm similar process of pathology as each tendon there are differences present.

The aim of this sytematic reivew was to summarize evidence in the last decade regarding the efficacy of physical therapy interventions to treat tendinopathy, as a single disease entity, as determined in systematic reviews (SRs) and/or meta-analyses (MAs).

40 SR & MA were included within the qualitative synthesis – only 5 MA were included within the quantitative synthesis. The articles inlcuded within the review were published between 2010-2020 within pubmed, PEDro, and Scopus. GRADE princliples and AMstar 2 tool were used to ensure methodological quality. Studies were only included if their objective was to
determine the efficacy of physical therapy intervention(s) in treating tendinopathy (without restriction to a specific anatomical site). Outcome measures included pain (VAS or NPRS) and function specific to each joint involved.


  • Eccentric exercise demonstrated positive effects in reducing pain and improving function. Suitable for long term management and improvement in function. This is consistent with existing literature.
  • Isometric exercises are effective for short term pain reduction
  • Eccentric exercise is likely effective due to neuromuscular adaptations, collagen synthesis and pain habituation. Optimal protocol is unknown.
  • Shockwave may be a useful treatment modality in reducing pain and improving function however there aren’t enough high quality studies to draw firm conclusions.
  • There is not enough evidence to draw firm conclusions about laser therapy.
  • Ultrasound was shown to be no more effective than placebo.

Clinical Implications

It appears that eccentric exercise is still the go to treatment for tendinopathies. Shockwave may provide an alternative option to reduce pain and allow an opportunity for pain to be reduced to a point where exercise can commence. Oh and we can all put the ultrasound machine away now.

Want to Learn More About Tendons from an Expert?

EBP in Tendinopathy
Evidence-based practice is about integrating best evidence research with clinical expertise as well as a patient preference. Applying an evidence-based practice approach to the management of tendinopathy is not as simple as applying one set of research findings, from a single article, in a recipe format for a patient. Every patient presents with a unique clinical picture. The therapist managing the patient should apply a broad base of evidence to clinically reason a comprehensive management plan. It is important that management is not recipe-driven but should be based on the best evidence available at that time bearing in mind that evidence-based practice is fluid and constantly changes as more evidence is produced.

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