The tendons are one of the body’s weakest links. While muscle and bone heal well after injury, the fibrous tissue that connects muscle to bone has a relatively poor blood supply, and for that reason, it recovers only slowly.

Inflammation in the tendon or its sheath is called tendonitis. Symptoms include tenderness, redness, swelling, and pain on exertion. These symptoms may last for months or years. Tendonitis occurs most commonly in the following areas: elbow (lateral epicondylitis or medial epicondylitis, also known as tennis elbow and golfer’s elbow), knee (peripatellar tendonitis), hip (iliotibial band tendonitis), shoulder (rotator cuff tendonitis), lower calf (Achilles' tendonitis), forearm, and thumb.

Overuse of a tendon (repetitive strain injury) is the most common cause of tendonitis. This form of injury frequently occurs in computer keyboard users, people who perform manual labor, and athletes (such as tennis elbow and golfer’s elbow). Acute injury to a tendon, such as an excessive stretch, can also cause tendonitis.

Conventional treatment consists primarily of avoiding the movement that caused the injury and allowing the body to heal on its own. Nonsteroidal anti-inflammatory drugs (such as ibuprofen) may help reduce pain, but have not been shown to speed recovery. Steroid injection into the affected tendon is thought to help in certain cases, but the scientific basis for this commonly used method remains weak at best.^1,2 The role of physical therapy in recovery from tendonitis also has not been well evaluated from a scientific perspective.¹⁰ A technique called extracorporeal shockwave therapy does not appear to work.¹¹

Principal Proposed Natural Treatments

Although the evidence remains incomplete and somewhat inconsistent, acupuncture treatment has shown considerable promise for the treatment of tendonitis.¹² Most studies have evaluated the effect of acupuncture on tennis elbow (lateral epicondylitis).

For example, a placebo-controlled, single-blind trial of 45 people with tennis elbow compared the effectiveness of real and sham acupuncture given twice weekly for 10 weeks.³ The results showed significant improvement in pain intensity and ability to use the elbow among those who received real acupuncture. Good results were also seen in a placebo-controlled study of 48 people with tennis elbow.⁴

Another study compared superficial insertion of acupuncture needles (sham treatment insertion) with normal deep insertion in 82 people with tennis elbow.⁵ The results showed greater improvement among the participants treated with deep acupuncture, at least in the short term. However, the difference was only temporary; by the 3-month follow-up, both groups were hurting to the same extent.

Benefits have also been seen in studies of people with tendonitis in the shoulder. A trial of 52 people with rotator cuff (shoulder) tendonitis found acupuncture more effective than sham acupuncture.⁶ In addition, a study compared superficial to deep-insertion acupuncture in 44 participants with shoulder pain and also found relative benefits, which lasted for at least 3 months.⁷ In another study, 117 people with rotator cuff injury (including tendonitis) were randomized to receive corticosteroid injections plus exercise or 10 acupuncture treatments plus exercise.¹⁶ Both groups experienced similar improvements in shoulder function and pain. Finally, in a sizable randomized trial, 425 patients receiving physical therapy for their persistent shoulder pain were divided into two groups: one received single-point acupuncture while the other received a sham treatment (mock transcutaneous electrical nerve stimulation) for three weeks.¹⁷ The acupuncture group showed significant improvement over the control group one week after treatment. However, not all studies have been positive. In a small trial of 32 patients with rotator cuff tendonitis, acupuncture was no better than placebo transcutaneous electrical nerve stimulation (TENS) when added to exercise.¹⁸

Laser acupuncture is a widely used substitute for needle acupuncture, but it may not be effective. A double-blind study of 49 people with tennis elbow failed to find 10 treatments with laser acupuncture more effective than the same number of treatments using fake laser acupuncture.⁸ Another study of 58 patients with the same condition found laser acupuncture to be no more effective than ultrasound treatments or wearing a brace.¹³

Other Proposed Natural Treatments

A form of massage called deep transverse friction massage has shown some promise for tendonitis, but as yet the research record is too weak to draw conclusions.⁹ Similarly, oscillating-energy manual therapy, an osteopathic technique based on the principle of craniosacral therapy, may be beneficial for tennis elbow (lateral epicondylitis), but more research is required to be sure.¹⁴

The supplements glucosamine and chondroitin are widely used for the treatment of osteoarthritis. Evidence suggests that they may work by enhancing the production of substances that keep cartilage healthy and flexible. On this basis, they have also been recommended for treating or preventing tendonitis. However, there is as yet no direct evidence that they work.

The herb white willow contains a substance called salicin, which is quite similar to aspirin. It seems likely that appropriate doses of the herb might offer some symptomatic relief for tendonitis.

Based on a small randomized trial, leech therapy (applying leeches to the painful area) may provide better short-term pain relief for people with tennis elbow compared to topical medicine (diclofenac).¹⁵

Other natural treatments sometimes recommended for tendonitis, but which lack scientific substantiation for that purpose, include prolotherapy and the following herbs and supplements

• Arnica
• Boswellia
• Bromelain
• Citrus bioflavonoids
• Creatine
• Devil’s claw
• Horse chestnut
• Manganese
• Oligomeric proanthocyanidin complexes (OPCs)
• Oxerutins
• Proteolytic enzymes
• Vitamin C