Ice. Especially at the end of a physical therapy session or a painful activity, ice offers many people good short-term pain relief. Ice, or cryotherapy, does not appear to affect the natural history of this disease either way Steroid injections (or help support your local orthopedist). Although such injections need to be properly given in regards to technique and number, these shots can dramatically decrease symptoms, usually taking about 4 or 5 days to do so. The most dramatic response can be seen in shoulder tendonitis and tennis elbow. This is fortunate, as these two are two of the most common, acute and chronic tendonitis conditions. In one form of shoulder or rotator cuff tendonitis, calcium deposits form in or near the rotator cuff tendons and can cause pain severe enough to prompt emergency room visits.
A steroid shot into the space just outside the rotator cuff (the bursa) can reduce pain like an off switch. Such injections for non-calcific acute and chronic rotator cuff tendonitis can often be extremely helpful. Steroid injections do not cause tendons to heal and if steroid is injected into the tendon structure. it can cause injury predisposing tendon rupture. Hence, it is the usual practice to avoid injection into the tendon itself. However, the injection for tennis elbow is intentionally placed into the footprint of tendon origin at the lateral epicondyle. This is likely why most practitioners will limit the number of injections per year and in total into this structure.
Braces, orthotics, and splints. These items help enforce rest. This is usually by limiting tendon excursion and hence, use. This will, then, necessarily interfere with normal local joint and tendon function, but that is the exact intention. Areas where this is particularly effective include a wrist splint for wrist tendonitis and knee splinting for tendonitis about the knee, quadriceps, patella and hamstrings. Orthotics can help with Achilles tendonitis by raising the heel and lower tendon peak loads and also help with posterior tibialis tendonitis by reducing midfoot collapse during the stance phase of walking. Perhaps, counter-intuitively, a wrist splint can be key for elbow tendonitis, either on the extensor side or flexor side. The stress on the tendons of origin at these elbow muscle groups is greatly diminished when one restricts motion of the attached muscles which are the wrist flexors and extensors. So by blocking wrist motion, one rests the forearm muscles and reduces tendon stress at the elbow anchoring site.
Correcting technique. In weight training and throwing, tendon injury from errors in technique are not only common, but frequently amenable to changes in technique. These changes in technique are usually part of the program that includes the other interventions listed in this section. A throwing coach and lifting trainer are key.
Workplace ergonomics. Although better for prevention than cure, there are several somewhat helpful changes that may decrease or prevent recurrence of symptoms.
Nutritional supplements. Sorry folks, but save your money. Now a multi-million dollar industry and as popular as tax refunds, there appears to be no convincing evidence that nutritional supplements help tendon healing or prevent tendon injury. Basic good nutrition may be as vital as oxygen to overall good health, but adding quantities of such items as Vitamin C, amino acids, glucosamine, and herbal extracts have not been shown to reduce injury or speed healing. The role of some supplements in reducing inflammation is hard to measure, and no standard effective recommendations seem to be available at present.
Body work and manipulation. If you like it, try it. Don't hold your breath waiting for these activities to speed tendon healing. Techniques in body work or manipulation that cause pain during or after a session should be viewed with the same caution that overwork and over-training and overuse, currently are.
