Current Treatments

By the time you feel pain from tendinopathy, your injury has been gradually building for many weeks. Remember that tendons heal slowly. You will probably need to wait several months before a reasonable amount of repair has occurred, so have patience with this slow healing process.

You'll need to avoid activities that cause pain, which can be a problem when some of those activities involve your work. Whenever possible, try to get the injurious aspects of your job done some other way (such as voice recognition software instead of keyboard typing), or try to change your job while you heal. Check with your doctor and physical therapist for specific suggestions and guidance.

You'll need to avoid activities that cause pain, which can be a problem when some of those activities involve your work. Whenever possible, try to get the injurious aspects of your job done some other way (such as voice recognition software instead of keyboard typing), or try to change your job while you heal. Check with your doctor and physical therapist for specific suggestions and guidance.

If you feel impatient with your injury, you might try to join a support group for RSI, whether it is a local group in your community or an online group. You can learn coping skills, get emotional support, learn about treatment options, and save yourself costly trial and error mistakes. People who have been there will tell you not to do more than your rate of healing will accommodate.

Peptides are chains of amino acids that can act as signaling agents in the body and can help control functions like wound and tendon healing. Some common peptides that are familiar to many people are insulin and oxytocin.

Longer peptides work best when injected subcutaneously, but some shorter peptides seem effective when used orally. A few peptides seem to work either in oral or injectable form, though sometimes with different effects (for example, BCP-157 seems to have better gut healing potential when used orally but better musculoskeletal healing potential when injected).

Peptide therapy has been available through some functional medical doctors who were ordering the peptides through compounding pharmacies. As of November 2023, the USA FDA banned compounding pharmacies from selling a number of peptides. Online groups exist to share information about the most reliable sources for peptides and the best protocols for their use. Peptide therapy is still experimental, but it looks promising. Human studies are lacking, and most human data is anecdotal. Some animal studies show impressive healing of tendons and muscles with the use of peptides.

Some of the peptides most commonly used for tendon healing include BPC-157, Thymosin Beta-4, and GHK-Cu. Peptides that enhance growth hormone, such as CJC-1295 and Ipamorelin, can also help tendon healing. Some peptides that help mitochondrial function, like SS-31 and MOTS-c, might also help heal chronic tendon injuries. An in vitro study found that SS-31 might be able to reverse some of the mitochondrial dysfunction that occurs in tendinopathy. Another study found that BPC-157 enhances growth hormone receptor expression in tendon fibroblasts. Much more research is needed, but peptides are exploding into the regenerative medicine and orthopedic fields.

Using ice packs, or cryotherapy, is one of the most common modalities for tendinopathy. Many physical therapists suggest that you use ice when you need some pain reduction. Don't use ice just prior to your exercises. Ice might not have any long-term beneficial effect on tendinopathy, but it can be an excellent form of pain control as long as you take care not to leave the ice on for too long at one time. Ice is also anti-inflammatory. Ice might inhibit healing if over-used, so therapists tend to suggest it mostly as a pain control agent.

Non-steroidal anti-inflammatories (NSAIDS) are commonly used to help reduce the pain of tendinopathy, but concerns have been building over the years that NSAIDs may actually impede the healing process in bone and tendon.  Early studies in vitro found that some NSAIDS impede the proliferation of tendon cells and the production of glycosaminoglycans. Later, a 2013 study in Journal of Applied Physiology postulated that NSAIDS may impede healing at the tendon to bone junction (enthesis), which is where tendinopathy often occurs. Another 2013 study, this one in Journal of Orthopedic Surgery and Research, into the effects of NSAIDS on tenocytes found that “pharmaceuticals such as DF (Diclofenac) and TA (triamcinolone acetonide) which are commonly used in the symptomatic treatment of musculoskeletal disorders may have profound negative effects on tendon regeneration on a progenitor cell level and therefore should be used with caution.”

NSAIDS are also associated with increased risk of heart attack/stroke and GI damage. One study in Osteoarthritis and Cartilage found that use of NSAIDS may be associated with the progression of osteoarthritis.

Because of all these concerns, long-term use of NSAIDs for tendinopathy is not a good idea, though they can possibly be helpful when used only short-term. This topic is still being debated and studied, especially as more research is done on the nature of the inflammatory component of tendinopathy.

Braces are often used for the wrist, elbow, knee, and ankle. Some people find that braces can add stability and support during activity. Braces should not be worn all the time because you can lose strength and flexibility, but they can be helpful if worn part-time. Some carpal tunnel syndrome patients like to sleep with wrist braces to avoid positions that cause numbness while sleeping. Ask your doctor or physical therapist if braces or supports might help you. If you try them, take care not to become too dependent on them.

Orthotics in your shoes can be very helpful if you have a structural imbalance that requires them. Check with a reputable podiatrist or sports doctor, and test the orthotics very gradually and cautiously (sudden changes in your position can make your injury worse)

Physical therapists sometimes perform friction massage and soft tissue mobilization. Many kinds of alternative medicine practitioners perform bodywork such as Feldenkrais and Alexander Technique. Some practitioners also try to help with your posture and body mechanics. Studies with rats have shown that soft tissue mobilization can increase fibroblast activity and speed healing. [48, 49]

Physical therapists usually say that massage can cause mild discomfort but should not cause intense pain. You'll need to learn how your body reacts; some people can have massage that causes discomfort at the time but they feel fine later, while other people can have the same level of discomfort during massage but a painful flare-up later. Sometimes a mild flare-up can lead to improvement later, and sometimes not. Proceed cautiously until you learn how your soft tissue reacts to various hands-on procedures.

A number of practitioners offer aggressive hands-on techniques to manually break up adhesions and stimulate healing by promoting tissue remodeling. Some approaches are more formalized with names and acronyms and are taught to practitioners following certain protocols. One approach is called Augmented Soft Tissue Mobilization or ASTM. These treatment programs are more likely to help people who have a specific injury to one location rather than someone with a propensity for chronic tendon trouble in multiple areas. Be sure you are a good candidate for this type of treatment before trying it. The idea of “breaking up adhesions” has been questioned, as summarized in this blog post by a sports medicine physiotherapist

Often called low intensity laser, cold laser, photobiomodulation, or red light therapy, many home devices are now available that combine red light with near infrared light for treating pain and injuries (as well as for improving skin appearance). These devices include hand-held LED lights and lasers, flexible pads and masks with an array of small LED lights, and sturdy panels of larger LED lights. The most common wavelengths used are 660nm (red) and 850nm (near infrared). Companies that supply these units include Bioflex, Novaalab, and Mito.

Pulsed electromagnetic fields, or PEMF, has been used to improve healing in bone fractures and to treat low back pain, and it has more recently been tried for tendinoparhy. Some preliminary studies in rats showed possible benefits for tendon healing, but we don't have enough research to know if it helps chronic tendon injuries in humans.

Surgery has been a last resort for tendinopathy. Some studies show positive results for surgery, especially in sports injuries, but you'll get a much more negative impression of surgical procedures from support groups. Perhaps surgery is more successful in athletes than non-athletes, or perhaps the people with the most stubborn injuries are the ones that end up in support groups. At any rate, investigate the surgical procedure thoroughly before you consider it for yourself, and be sure to give your injury plenty of time to heal on its own before you resort to surgery.

When surgery is indicated, some new methods are being employed, such as the Tenex Health TX method, for removing damaged tissue. This technique is minimally invasive (much smaller incision) and has a shorter recovery time than traditional open surgery. A video of an actual procedure along with more explanation is available on The Doctors, and patient information and testimonial videos are available on the Tenex website.

Basic good nutrition is advisable in order to give your body the best chance to heal, but not much scientific research has been done to investigate the effects of specific nutritional supplements on the healing of tendinopathy. If you are overweight and/or have diabetes, your tendons may improve by losing weight and improving your blood sugar; studies have shown a correlation between diabetes and tendinopathy.

Ascorbic acid (vitamin C) stimulates Type I collagen synthesis when used in cultures of healthy fibroblast cells. However, when ascorbic acid was added to cells from carpal tunnel syndrome patients, it did not stimulate the normal amount of Type I collagen, and the small amount of Type I collagen that was produced had an abnormally high alpha2(I) to alpha1(I) ratio.[1] Adding vitamin C to the injured cells simply made them produce more abnormal collagen, not normal collagen. You want to have enough vitamin C in your diet, but vitamin C alone is not likely to fix your tendinopathy.

Some supplements that claim to help heal tendons and ligaments contain the amino acids glycine, lysine, and proline. This idea seems logical since those three amino acids are very abundant in tendon and ligament collagen. However, merely providing more amino acids probably won't change the injured tenocyte behavior of making abnormal collagen. Still, you should be sure to get enough high-quality protein in your diet so you're not deficient in amino acids. Many health and longevity experts cite recent research showing that the current RDA for protein is not high enough for optimal health; as we age, we need more protein to avoid sarcopenia. See this episode on Peter Attia's podcast or YouTube channel as an example of this new outlook on protein intake.

Collagen peptides have become popular for the health of skin, joints, cartilage, and tendons. Collagen peptides are amino acid chains that are the building blocks of collagen. The hope is that the peptides might work not just as raw ingredients for collagen building, but also as signaling agents that could help stimulate collagen synthesis. This strategy might work better for healthy skin and tendon than for injured tendon, but one supplement in particular, TendoForte, has some research behind it. A study in patients with Achilles tendinopathy found that taking TendoForte in combination with an exercise program did better than a placebo with the exercise program. Other collagen supplements offered by other brands might be helpful, but more research is needed.

Although glucosamine sulfate and chondroitin sulfate might help osteoarthritis, they are not likely to help tendinopathy. Osteoarthritis causes a decrease in collagen, proteoglycans, and glycosaminoglycans (GAGs) in cartilage. Tendinopathy causes a decrease in collagen in the injured tendon, but it actually causes an increase in proteoglycans and GAGs, such as chondroitin sulfate and hyaluronan.[7,8,13,18,40] Gluscosamine sulfate and chondroitin sulfate might help build proteoglycans, but since the levels of GAGs and proteoglycans are already abnormally high in tendinopathy, you wouldn't expect oral supplementation of glucosamine and chondroitin to help.

Some foods and supplements, such as ginger, turmeric, and fish oil, can help reduce inflammation. Eating an ant-inflammatory diet is good for your general health and might be especially good when you are trying to heal soft tissue injuries. One active ingredient in tumeric root, curcumin, is available as a supplement with piperine added for better absorption or in phytosome form for more bioavailability. Thorne's curcumin phytosome has some research behind it for various anti-inflammatory effects. Look for fish oil that is low in contaminants and low in oxidation (the IFOS testing site can help).

In addition to some targeted supplements, you'll want to maintain a healthy weight and eat a whole foods diet with plenty of protein and antioxidant-rich whole fruits, vegetables, and nuts, while eating minimal amounts of trans fats, simple carbohydrates, and processed foods. People can respond differently to various foods and diet plans, so you need to see what works best for you. A functional medicine doctor can run lab tests to check levels of inflammatory markers in your blood like CRP-HS, as well as hormones, A1C, lipids, and other useful measures of health. Keeping blood glucose in a good range is vital for minimizing inflammation. If you are sensitive to gluten or dairy, it might help to eliminate those from your diet. For more information about healthy nutrition, see sites/chanels such as NutritionMadeSimple, PeterAttiaMD.com, NutritionFacts.org, and DrWeil.com. Conflicting information exists about diet, so you need to research and see what makes most sense to you. Improvements from good diet can take a little time to notice, so be patient.