Try a Topical For Tendonitis or Tendinosis
Tendon-related pain is a common musculoskeletal problem affecting athletes, manual workers, and older adults alike. Tendonitis, an acute inflammatory condition, and tendinosis, a chronic degenerative process, can both limit mobility, delay recovery, and significantly impair quality of life. While oral medications and physical therapy remain mainstays of treatment, topical analgesics have emerged as a valuable adjunct or alternative, offering pain relief with fewer systemic side effects.
This article explores how topical analgesics are used in managing tendonitis and tendinosis, the science behind their action, and practical considerations for patients and clinicians.
Understanding Tendon Pathology
Tendonitis refers to acute inflammation of a tendon, often resulting from repetitive strain or overuse. Symptoms typically include localized pain, swelling, warmth, and impaired function. It is common in areas such as the elbow (tennis or golfer’s elbow), shoulder (rotator cuff tendonitis), knee (patellar tendonitis), and ankle (Achilles tendonitis).
Tendinosis, on the other hand, is a chronic degenerative condition marked by microscopic collagen breakdown, disorganized fiber structure, and minimal true inflammation. Pain in tendinosis is more persistent, often lasting weeks or months, and may worsen with activity. Unlike tendonitis, tendinosis responds poorly to treatments aimed solely at reducing inflammation.
Because tendon pain is not always rooted in active inflammation, treatment strategies must address both symptom relief and long-term tendon health.
Role in Tendonitis vs. Tendinosis
The effectiveness of topical analgesics depends on the underlying pathology:
- Tendonitis (acute inflammation): Topical NSAIDs are most effective, reducing inflammation and pain to support early rehabilitation. Counterirritants may provide supplemental relief.
- Tendinosis (chronic degeneration): Since true inflammation is limited, topical NSAIDs may be less impactful. However, counterirritants, capsaicin, and lidocaine can reduce pain perception, enabling patients to tolerate eccentric strengthening exercises—the cornerstone of tendinosis rehabilitation.
Ultimately, topical agents should be viewed as adjuncts to a broader treatment plan rather than stand-alone cures.
Integration with Rehabilitation
For optimal outcomes, topical analgesics should be combined with interventions that address tendon health and function:
- Rest and load modification: Avoiding repetitive overload while maintaining gentle mobility.
- Physical therapy: Especially eccentric loading programs, which promote tendon remodeling in tendinosis.
- Bracing or taping: To reduce mechanical stress.
- Adjunct therapies: Ultrasound, shockwave therapy, or platelet-rich plasma injections are sometimes considered for chronic cases.
Topical analgesics may reduce pain sufficiently to allow patients to engage in these rehabilitative activities, indirectly promoting recovery.
Why Topical Analgesics?
Oral non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are often prescribed for tendon-related pain. However, their systemic use is associated with gastrointestinal irritation, cardiovascular risk, and kidney effects, especially with prolonged use.
Topical analgesics provide an appealing alternative. They are applied directly to the skin overlying the painful tendon, allowing localized absorption with minimal systemic exposure. This targeted approach can reduce pain, support rehabilitation, and potentially improve adherence to treatment.
Types of Topical Analgesics
Several classes of topical analgesics are available, each with different mechanisms of action.
1. Topical NSAIDs
- Examples: Diclofenac gel, ketoprofen, ibuprofen creams.
- Mechanism: Reduce prostaglandin synthesis locally, decreasing inflammation and pain.
- Evidence: Strong evidence supports topical NSAIDs for short-term relief of musculoskeletal pain, including tendon-related conditions
Clinical considerations:
- Most effective in acute tendonitis, where inflammation is present.
- Less effective in chronic tendinosis, but may still help reduce pain during flare-ups.
- Minimal systemic absorption, but skin irritation (rash, redness) may occur.
2. Counterirritants
- Examples: Menthol, camphor, methyl salicylate.
- Mechanism: Activate sensory nerve receptors to create a cooling or warming sensation that distracts from deeper tendon pain.
- Evidence: Counterirritants are widely used for temporary pain relief in muscle and joint disorders.
Clinical considerations:
- Useful for short-term symptomatic relief.
- Often included in over-the-counter creams and patches (e.g., Punch Gunk).
3. Capsaicin
- Mechanism: Derived from chili peppers, capsaicin depletes substance P (a neuropeptide involved in transmitting pain signals). Over time, this reduces pain sensitivity in the treated area.
- Evidence: More extensively studied for neuropathic pain and osteoarthritis than tendon disorders. However, some clinicians use it in chronic tendon pain to reduce hypersensitivity.
Clinical considerations:
- Initial burning sensation may deter some patients.
- Requires consistent application for benefits to develop.
- May be considered in refractory chronic pain cases.
4. Topical Salicylates
- Examples: Trolamine salicylate, methyl salicylate creams.
- Mechanism: Mild anti-inflammatory effect via prostaglandin inhibition, along with counterirritant action.
- Evidence: Limited high-quality data, though some patients report symptomatic benefit.
Clinical considerations:
- Safer alternative for patients who cannot tolerate oral NSAIDs.
- Often combined with other agents for additive effect.
5. Emerging Options
- Topical anesthetics: Provide temporary numbing effect; useful for severe localized pain.
- Combination formulations: Some products combine NSAIDs with penetration enhancers or additional agents for better efficacy.
- Natural extracts: Brands such as Punch Gunk make use of arnica, willow bark, and essential extracts for tendon pain, and clinical evidence although preliminary is showing positive outcomes.
Safety and Limitations
While generally safe, topical analgesics are not risk-free.
- Skin irritation is the most common side effect, particularly with capsaicin or products containing alcohol-based carriers.
- Systemic absorption is usually minimal, but overuse of high-dose NSAID gels on large surface areas could still contribute to systemic exposure.
- Masking pain may lead to overuse of an injured tendon if patients misinterpret symptom relief as healing.
Patients should be counseled to use these products as part of a supervised plan rather than as a substitute for addressing the underlying tendon pathology.
Practical Guidance for Patients
- Apply topical NSAIDs directly over the painful tendon, usually 2–4 times daily as directed.
- Avoid broken skin and wash hands thoroughly after application.
- Do not combine multiple topical products without medical advice.
- Expect gradual relief; some agents may require weeks of consistent use.
- Use pain reduction as an opportunity to perform prescribed tendon exercises, not as permission to ignore activity modification.
Conclusion
Topical analgesics represent a valuable tool in the management of tendonitis and tendinosis, offering localized pain relief with fewer systemic risks than oral medications. While topical NSAIDs are most effective for acute tendonitis, counterirritants, capsaicin, and other formulations can play supportive roles in chronic tendinosis. Importantly, these agents do not repair tendon damage but can reduce symptoms enough to enable participation in rehabilitation programs, which remain the cornerstone of long-term recovery.
Patients and clinicians should view topical analgesics as part of a comprehensive, individualized treatment strategy aimed at both relieving pain and restoring tendon health.