Steroid Treatment for Tendon Pain: Help or Hindrance in Rehab?


Tendinopathy is a condition common to overburdening of a tendon.

When an athlete or other patient seeks traditional medical attention for tendon pain, the first line of treatment is often corticosteroid injections (CSI) to reduce inflammation and ease discomfort.

Oftentimes, steroid injections are given in conjunction with physical therapy, to help the patient withstand the discomforts associated with therapeutic exercises. However, new research suggests that CSI may actually interfere with physical therapy and delay rehabilitation.

Effect of Exercise on Tendon Structure

Overload is the principle by which muscle and tendon cells become stronger. The idea is to stimulate an adaptive response at the cellular level. Overload is the underlying principle of the maxim, “No pain, no gain.”

It has been demonstrated that slow eccentric (muscle lengthening) movements performed with heavy resistance have a positive effect on strengthening and repairing tendon tissue. Exercise stimulates the formation of new collagen and matrix proteins within the tendon, a process called mechanotransduction, meaning exercise has a positive effect on tendon structure.

CSI Effect on Tendon Tissue

Emerging research suggests that while CSI treatment has a positive short-term effect on pain reduction, CSI may interfere with and delay tendon recovery. It appears that local glucocorticoid injections may have a harmful effect on newly forming tendon cells, reducing their viability and proliferation, and delaying the synthesis of collagen.

In addition to tendon cells in the long run.

Studies on CSI and Tendinopathy Rehab

A growing body of research points to the potentially harmful effects of CSI on tendon rehabilitation:

  • Coombes et al. (2016) studied patients with lateral elbow tendiopathy and found that recovery outcomes were delayed and reduced in patients who had CSI treatment. The researchers concluded that CSI should not be regarded as a first-line treatment for tendinopathy.
  • In a review of studies on lateral hip pain, Lustenberger et al. (2011) noted that a significant number of patients who had multiple CSI treatments eventually ended up having surgery, although no direct correlation was implied. The research team found shock wave therapy to CSI.

While evidence about the effect of CSI on tendon recovery is inconclusive, patients with tendinopathy, especially athletes whose careers hinge on recovery, should be wary of CSI as a first line of treatment.

Tendinopathy Treatment in NYC

The skilled sports medicine practitioners at NYDNRehab understand the importance of full recovery from tendinopathy for athletes and anyone who wants to the source of the problem.

If you are suffering from tendinopathy or other types of muscle pain, NYDNRehab can help. Our progressive clinic uses state-of-the-art technology to your active lifestyle.



In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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