In a video published on his Instagram account, physiotherapists Hervé Verwaerde (aka @HemTonKine) and Valentin Copin (@motion_therapy_expert) remind that in the event of tendinitis, infiltration should not be an automatic reflex. The right idea to remember: progressive exercises are often the basic treatmentwhile infiltration can be of occasional interest, depending on the situation.
Why infiltration is not a reflex
In common parlance, we often speak of “tendinitis”. But when the pain lasts, the term tendinopathy
is often more accurate: not all tendon pain is linked to simple inflammation. This is one of the important points raised by experts: if inflammation is not always the main driver of pain, injecting a local anti-inflammatory does not necessarily address the underlying problem.
The French recommendations go in this direction for certain locations, in particular non-traumatic tendinopathy of the rotator cuff of the shoulder. The High Authority of Health (HAS) indicates that the infiltration of corticosteroids is not systematic as first intention. It can be considered after medical evaluation, for example when symptoms persist despite the first measures, and it should not be repeated if it does not bring lasting improvement.
Another essential nuance: infiltration is not “useless” in principle. It can sometimes reduce pain in the short term and help a person return to rehabilitation. But it does not replace progressive work on the tendon. The review published in The Lancet in 2010 shows that corticosteroid injections can reduce short-term pain in certain tendinopathies, with less favorable medium and long-term results depending on the location. We cannot therefore generalize : it all depends on the tendon concerned, the phase of the pain and the medical context.
Experts also emphasize a point of caution: corticosteroids can pose a problem for the tendon. The wording must remain measured: it is not a question of saying that an infiltration always “destroys” the tendon, but rather that the infiltrations are not trivial and can weaken a tendon, especially if they are repeated or performed in an unsuitable context.
What exercises really do for the tendon
In the accompanying text, the physiotherapists summarize their message as follows:
“Often the best tool remains exercises.”
This sentence is useful if understood correctly. The exercises are not a universal recipe applicable to all pain, nor proof that infiltration would always be a bad option. But they are often central because a tendon needs progressive reloading to adapt. This is also one of the reasonings of the video: a tendon does not strengthen with only passive treatment, but with well-balanced mechanical constraints.
For the shoulder, the HAS describes, for example, active care combining progressive strengtheningmaintenance of joint range of motion, proprioceptive work and self-rehabilitation program. Clinical improvement is generally expected over several weeks to a few months, which highlights an important point: in tendinopathy, basic treatment often requires regularity, not just a one-off procedure.
Concretely, the objective is not to “force despite the pain”. Exercises should be adapted to the location, intensity of symptoms and functional level. To better understand this logic, True Medical also details the progressive reloading of the tendon and suggests, for frequent localization, exercises to strengthen the Achilles tendon.
An infiltration is therefore discussed on a case-by-case basis with a healthcare professional, particularly when:
- The pain remains very significant and prevents daily activities or sleep;
- The symptoms persist despite the first appropriate measures;
- The person has diabetes, anticoagulant or antiplatelet treatment, because the procedure requires specific assessment and precautions;
- A previous infiltration did not bring lasting benefit.
The right message is therefore not “infiltration versus exercises”, but rather: infiltration can provide relief in certain indicationswhile progressive exercises aim more at functional recovery and adaptation of the tendon over time.