Treatment	Mechanism	Effectiveness	Risks
Rest	Reduces strain on painful tissue	First-line treatment; used as control in some studies	Few risks; time required may not be acceptable (e.g., missed work or competition)
Bracing	Reduces strain on surrounding muscle groups; can also be a form of rest	Evidence varies for location and type of brace21–24	Prolonged immobilization can lead to stiffness and atrophy; should be used in combination with physical therapy
Corticosteroid injections	Anti-inflammatory effects	Better than rest alone and equal to NSAIDs for short-term treatment of chronic tendinopathy25; similar to physical therapy and NSAIDs for rotator cuff tendinopathy without impingement26; short-term benefit (less than six months) for lateral epicondylitis27	Local pain and atrophy, skin depigmentation, rare risk of tendon rupture; repeated injections are more harmful than a single injection27
Cryotherapy/icing	Anti-inflammatory effects; direct application over tendon or ice cup massage	Few studies for chronic tendinopathy28–30	Few risks
Eccentric exercises	Loading tendon to promote structural remodeling and repair	Good evidence of benefit for midsubstance Achilles tendinopathy, rotator cuff tendinopathy, lateral epicondylitis, and patellar tendinopathy14,15,25,30,31	Few risks; if guided by a physical therapist, barriers may include cost, transportation, and time off work
Extracorporeal shock wave therapy	Microsecond pressure pulses of energy directed at 2- to 8-mm areas; electrohydraulic, electromagnetic, or piezoelectric source; therapeutic mechanism unknown	Good evidence for high-dose energy-focused therapy for plantar fasciitis, greater trochanteric pain syndrome, and calcific rotator cuff tendinopathy, but not noncalcific rotator cuff tendinopathy or lateral epicondylitis25,32	Noninvasive; adverse effects are rare but include pain and risk of tendon injury; equipment is expensive
NSAIDs	Anti-inflammatory and analgesic effects; unclear why NSAIDs are effective because chronic tendinopathy is a degenerative and noninflammatory process	Some benefit for short-term treatment of chronic tendinopathy, but evidence wanes as treatment duration increases, which may represent more refractory cases; inexpensive and patient controlled3,4,13,25	Gastrointestinal, renal, and cardiovascular risks with long-term use
Platelet-rich plasma injections	Platelets produce growth factors that are beneficial to tissue repair and regrowth; activity is limited after the procedure with physical therapy–driven protocol	Cochrane review showed no functional benefits compared with placebo, dry needling, whole blood, or no intervention, but a subgroup of studies showed short-term benefit for pain33; a meta-analysis showed no benefits, but protocol was not standardized34; a meta-analysis found benefit when leukocyte-rich platelet-rich plasma was used with ultrasound guidance35; two randomized controlled trials showed no benefit for Achilles tendinopathy36,37; some experts think benefit might be derived from dry needling/fenestration alone38	Often not covered by insurance; can be expensive and painful
Therapeutic ultrasound	High-frequency, low-power ultrasound; similar to imaging ultrasonography, but beams are focused on a small area rather than spread for visualization39; causes cavitation (creation of small gas bubbles) and acoustic streaming (eddying of fluids near vibrating structures), which affect energy across cell membranes; thought to stimulate metabolic processes that accelerate growth factor and collagen synthesis and repair (mediates inflammatory process)40	Some benefit for lateral epicondylitis and calcific rotator cuff tendinopathy; systematic review showed no benefit for noncalcific rotator cuff tendinopathy39,41	Discomfort, mild pain
Topical nitroglycerin	Enhances collagen synthesis and other relevant healing factors; many studies used one-fourth of a 5-mg patch	Improves pain with activity; conflicting evidence for pain at rest; no effect on pain duration for chronic tendinopathies25,42	Contact dermatitis, headaches; takes time to be effective
Ultrasound-guided debridement	Debridement with irrigation and suction removes diseased tendon; ultrasonography is used to identify areas of disease; similar to surgical debridement but is performed in the office with a small incision	Case series showed benefit for lateral epicondylitis43,44; chart review showed benefit for insertional Achilles tendinopathy45	Limited case studies show adverse effects (e.g., tendon rupture) or evidence of tendon injury due to the procedure46