When a tendinopathy is diagnosed, one of the first-line treatments is a specific and appropriate physiotherapy programme. The wrong exercises can be at best ineffective and at worst can aggravate the problem. The right ones can help many tendinopathies to being cured early on.

We believe in prescribing simple physiotherapy programmes that are targeted to the individual problem and to the individual with the problem.

Our Specialist Physiotherapists understand that the aim should be to have the minimum number of different types of exercise to make the exercises easier to fit in to our clients lives, and therefore more likely to be done.

We use topical glycerly trinitrate patches to speed tendon healing in selected cases.

This treatment relies on the fact the that nitric oxide that is released by the patches in small quantities, has been shown in various studies to have a positive effect on tendon healing after injury.

Not everyone is suitable for this treatment and so we use it in selected cases.

This is another non-invasive treatment that harnesses the healing effect of acoustic (shock) waves to heal tendons. We have huge experience of using this novel treatment in patients with tendinopathies that have failed to improve with other treatment method.

It is performed in the clinic room and has no side effects, requires no special preparation, does not require time off work and is very well tolerated. Patients do not need pain-killers after treatment. It reliably relieves symptoms in 60-80% of cases, depending on the specific tendinopathy being treated.

Not all Shock Wave treatments and machines are the same. We use mostly radial but some focussed shock wave therapy using the Swiss Dolorclast machine. This machine has a huge evidence base, unlike some other machines that are available.

Platelet-rich plasma (PRP) injections harness the healing cells in our own blood to help cure tendinopathies.

Sometimes jokingly called the “Dracula cure” (especially when used in cosmetic procedures) this relies on the fact that the platelets in our blood have healing properties. A small amount of blood is taken from the patient with a tendinopathy, and it is spun down with a centrifuge and prepared to isolate the platelet-rich cells. These are then injected into the area of tendinopathy.

This is a relatively new treatment option and so not many studies are available about its effectiveness. We tend to use this treatment where non invasive treatments, such as physiotherapy, patches and shock wave therapy have failed. Our results indicate that about 60-70% of this group of patients benefit from the treatment.

There is some evidence that other types of injection can help in tendinopathy. The evidence is less clear but some certainly appear promising without having any significant side effects. Hyaluronic acid injections and Traumeel injections fall into this category and we use these in selected cases.

A newer injection is Amniofix which contains growth factors and is showing encouraging results. We are reviewing it as a treatment to offer to our patients.

When non-invasive and injection treatments fail, we first consider minimally invasive surgery performed under local anaesthetic. It should be noted that a vast majority of our patients never get to this stage as we cure them with other treatment methods.

However, not everyone is cured and so the option of minimally-invasive surgery is available where required. These are day-case procedures that can be performed in the clinic without the need for admission to hospital.