Physical therapy for tendinopathy: An umbrella review of systematic reviews and meta-analyses

Phys Ther Sport. 2020 Nov:46:30-46. doi: 10.1016/j.ptsp.2020.08.002. Epub 2020 Aug 11.

Abstract

Objective: To summarize evidence in the last decade regarding the efficacy of physical therapy interventions to treat tendinopathy, as a single disease entity, as determined in systematic reviews (SRs) and/or meta-analyses (MAs).

Methods: Electronic search of PubMed, PEDro, and Scopus database was performed from year 2010 to January 2020. The methodological quality of the identified studies was assessed using the AMSTAR 2 tool. Studies scoring 9 points or higher were further analyzed using GRADE principles.

Results: 40 SRs and/or MAs were included in qualitative synthesis, whereas only 5 MAs were included in quantitative synthesis. Low-level laser therapy (LLLT) intervention showed a pooled improvement in pain reduction of 1.53 cm; 95% CI, [1.14, 1.91] (I2 = 1.9%, p = 0.361) on visual analogue scale, and grip strength of 9.59 kg; 95% CI, [5.90, 13.27].

Conclusions: Moderate-quality evidence may support these following interventions: LLLT revealed a statistically and potentially clinically significant improvement in pain and function on the short-term. Extracorporeal shockwave therapy showed a statistically significant enhancement in pain and function at all follow-up durations; however, its clinical significance was undetermined. Eccentric exercise was supported by qualitative evidence only. Caution is advised when interpreting results due to possible pathological differences in tendinopathy at each region.

Keywords: Conservative treatment; Review; Tendinopathy; Tendon injuries.

Publication types

  • Review

MeSH terms

  • Exercise
  • Exercise Therapy / methods
  • Extracorporeal Shockwave Therapy / methods
  • Humans
  • Iontophoresis / methods
  • Low-Level Light Therapy / methods
  • Meta-Analysis as Topic
  • Musculoskeletal Manipulations / methods
  • Orthotic Devices
  • Pain
  • Pain Measurement
  • Physical Therapy Modalities*
  • Systematic Reviews as Topic
  • Tendinopathy / therapy*
  • Transcutaneous Electric Nerve Stimulation / methods
  • Ultrasonography / methods