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Evidence-backed treatments include: Isometric exercises, which can help with pain control Heavy slow resistance training and eccentric loading to stimulate healing Supportive therapies like shockwave, topical NSAIDs, or in some cases injections When tendon degeneration is severe, we often focus on strengthening the healthy parts of the tendon what some clinicians call treating the doughnut, not the hole. Recovery takes time, consistency, and a plan tailored to the person not a quick fix

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Anti-inflammatory mechanisms include modulation of inflammatory cytokines and reduction of nuclear factor-kappa B (NF-B) activity, a key inflammatory pathway