TREATMENT Treatment is mainly conservative and focused on rehabilitation to restore the tendon’s ability to tolerate load. This rehabilitation will be enhanced by Photobiomodulation (PBM) and/or ESWT. The role of photobiomodulation (PBM): PBM has proven to be very effective in the management of tendinopathies. In order to promote collagen organisation, a contact head could assist, to be applied in the direction of the fibres.
The most firmly established benefit, directly linked to the mechanism of action is on Cytochrome C Oxidase (CCO)
Pain reduction : PBM is used to rapidly reduce pain during acute or exacerbation phases (Cook and Purdam, Phase 2 or 3). By inhibiting nerve conduction and modulating pain mediators, it creates a crucial therapeutic window. The clinical benefit is that a less painful tendon is a tendon that can be loaded more effectively and earlier (optimal loading), thus accelerating the transition to the strengthening phases.
Inflammation control (tissue reaction): Although tendinopathy is tendinosis (degeneration) and not tendinitis (classic inflammation), there is a local inflammatory and metabolic reaction. PBM helps modulate this reaction and reduce oedema (tendon thickening often seen on ultrasound).
Main objective
Phase of Tendinopathy (Cook and Purdam)
Recommended Dosage (Indicative)
Frequency/ Duration
Area of Application
Hypoalgesia and Therapeutic Window
Stages 2 and 3 (Pain limiting exercise)
Moderate (4 to 8 J/cm 2 )
3 times/week, just before strengthening exercises.
Lower pole of the patella and painful area of the tendon.
Tissue remodeling & collagen
Phases 1 and 2 (Progressive loading phase)
Moderate (6 to 12 J/ cm 2 ) Strong on quadriceps (15 to 20 J/cm 2 )
2 to 3 times/week.
Targets the proximal and posterior portion of the patellar tendon (critical area). Don’t forget the quadriceps
Neovascularization
Chronic and refractory cases
Moderate to high (8 to 15 J/cm 2 )
Twice a week.
The tendon, to improve nutrient supply
Stimulation of fibroblasts and collagen: The increase in ATP stimulates the proliferation of tenocytes (tendon cells) and improves the production and organization of type I collagen. The aim is to improve the quality of the tendon matrix by accelerating the degenerative remodeling process towards a healthier and more resistant matrix. 16
Improved microcirculation: PBM-induced NO release promotes local vasodilation, improving nutrient supply and metabolic waste elimination in the tendon, a naturally poorly vascularized structure.
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