“Corticosteroid injections are more effective than physiotherapy or rehabilitation in treating chronic tendon injuries.”

Although local corticosteroid injections are one of the most common treatments, there is no good evidence to support their use in chronic tendon lesions. This is due to either a true lack of effect or a lack of good trials. Inhibiting the healing process, if inflammation is present, may result in a suboptimal outcome.

At mid- and long-term follow-up assessments corticosteroid injection seemed not to be more effective than any physical therapist interventions. Corticosteroid injection(s) seems not to be superior to physical therapist interventions, other than resulting in some transient improvements at short term if provided together with other physical therapist interventions, in adults with rotator cuff tendinopathy. Furthermore, considering the potential adverse events associated with the injections, physical therapist interventions may be an important stand-alone treatment option.

Coombes and colleagues' analysis implies that specific exercise therapy might produce more cures at 6 and 12 months than one or more corticosteroid injections, and such was the case in Coombes and colleagues' analysis. For lateral elbow tendinopathy (tennis elbow), there was a 21% reduction in the relative risk of overall improvement 1 year after corticosteroid injection compared with patients allocated to wait and see.

We found strong evidence that corticosteroid injection was beneficial in the short-term but inferior to most comparisons in the intermediate and long term. Trials comparing corticosteroid injection to physiotherapy, found no differences in pain or function, although significantly greater numbers of patients reported complete recovery following corticosteroid injection at 6 weeks (RR 3.06, 95% CI 1.27 to 7.39).

We showed consistent findings between many high-quality randomised controlled trials that corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms. For example, in pooled analysis of treatment for lateral epicondylalgia, corticosteroid injection had a large effect on reduction of pain compared with no intervention in the short term, but no intervention was favoured at intermediate term and long term.

Corticosteroid injection is beneficial in the short term for the treatment of tendinopathies but may be worse than other treatments in the intermediate and long terms. In comparison with physiotherapy (4 studies), corticosteroid injection was more effective in the short term for improving function and in overall improvement, and there was strong evidence among heterogeneous studies for reducing pain. Intermediate and long-term results were worse in pain and function for the corticosteroid injection intervention.

Management typically includes conservative therapies, such as physical therapy, corticosteroid (CS) injections for short-term relief, and platelet-rich plasma (PRP) as a regenerative therapy with potential long-term benefits. PRP and CS injections demonstrated no significant difference in short-term pain reduction. Functional outcomes were comparable in the short term but showed a trend favoring PRP at longer follow-up periods.

Our review suggests corticosteroid injection provides beneficial short-term effects and physical therapy interventions provide intermediate to long-term effects, less additional treatment and low recurrence rate in patients with lateral elbow tendinopathy.

A landmark systematic review published in The Lancet evaluated the efficacy and safety of corticosteroid injections for tendinopathies across 41 randomized controlled trials. The findings were striking: cortisone injections reduced pain in the short term, but this benefit reversed at intermediate and long-term follow-up (Coombes et al., 2010). The growing body of evidence suggests that repeated use carries real risks to both tendon integrity and cartilage health.

The goals of tendinopathy treatment are to relieve pain, reduce irritation and prevent future tendon conditions. Physical therapy exercises can help strengthen the muscle and tendon in the affected area. You can do resistance exercises to effectively treat many long-lasting, called chronic, tendon conditions. The effectiveness of steroid shots for tendinopathy varies depending on the site.

Corticosteroid injections near areas of tendinopathy are helpful for short-term but not long-term treatment. However, they have a small risk of tendon rupture. Subacromial corticosteroid injections are commonly used to provide short-term pain relief, which can be useful when initiating physical therapy.

Advancements in sports medicine and rehabilitation have underscored the effectiveness of physical therapy in treating tendon issues. Research supports the use of progressive loading exercises (eccentric exercises, for example) and tailored rehabilitation protocols to promote tendon healing and improve outcomes. The review highlighted that tailored exercise programs focusing on progressive tendon loading can lead to improved clinical outcomes, including reduced pain and improved function.

The lasting solution comes from guided, active recovery. Physical therapy for tendonitis helps the body heal properly by restoring strength, flexibility, and movement control, leading to lasting relief. While rest can help reduce irritation in the short term, it does not strengthen the tendon or improve its ability to handle stress.

Studies have shown that compared to cortisone injections, PT has required less one year returns to the doctor for related issues, and less pain and functional disabilities after a full year following completion compared to cortisone injections. Not only is PT effective in the present but it's been shown to be more effective in the long term without the side effects or repeated need for injections in the future.

Our study provides long-term data for athletes with PT following current quality of care using comprehensive patient-reported outcomes. We observed a self-perceived recovery rate of 76% and return to desired sport rate of 71%, along with sustained improvements in pain levels, disability, and quality of life.

Physical therapy offers one of the most effective non-invasive treatments for tendonitis, helping patients recover functionality, reduce pain, and prevent re-injury. Eccentric exercises are among the most effective physical therapy techniques for managing tendonitis. Several studies have shown that eccentric training not only reduces pain but also helps remodel damaged tendon fibers, allowing for proper healing.

At a mean follow-up of 5 years, 76% of participants felt recovered. Pain levels during sports and VISA-P score significantly improved from baseline to 5 years.

According to current research, the gold standard treatment is a progressive exercise-based program, tailored to the individual and the specific tendon involved (Couppé et al, 2015). Recovery from tendinopathy is not quick, tendon tissue heals slowly due to limited blood supply. While mild cases can improve in a few weeks, most cases require 8–12 weeks of consistent rehab, and more chronic conditions can take 3–6 months or longer.