What Are Tendinopathies?
In sports medicine, tendinopathies are among the most common causes of prolonged absence from sporting activity. They are degenerative changes in tendon tissue that develop gradually as a result of repetitive mechanical loading without sufficient recovery time. This leads to disruption of the collagen structure, microtears and reduced mechanical strength.
Tendinopathies affect athletes of all ages and performance levels, but are particularly common in endurance athletes and in sports involving jumping or throwing. The most frequently affected areas are the Achilles tendon, the patellar tendon, commonly associated with jumper’s knee, the rotator cuff tendons of the shoulder and the tendons of the elbow.
Characteristic symptoms include pain that begins mildly and progressively worsens, stiffness—particularly in the morning or after prolonged rest—and reduced power or endurance in the affected limb.
How Do Tendinopathies Differ from Tendinitis?
The main difference between tendinopathy and tendinitis is the absence of pronounced inflammatory activity. In tendinopathy, the predominant process is degeneration of the tendon tissue rather than inflammation.
This explains why conventional non-steroidal anti-inflammatory drugs (NSAIDs) often provide limited benefit: they target inflammation, which is not the primary pathological process.
Vascularisation also plays a central role. Under normal conditions, certain areas of tendons already have a limited blood supply, and these are usually the first areas to undergo degeneration.
Repetitive loading further compromises this blood supply, creating a cycle of local hypoxia and reduced regenerative capacity. In advanced cases, the risk of complete tendon rupture increases significantly.
Scientific Evidence
The scientific evidence supporting the use of hyperbaric oxygen therapy in athletes with tendinopathies continues to grow. Studies involving athletes with chronic Achilles and patellar tendinopathy have reported improvements in tendon histology, including increased type I collagen and reduced type III collagen, as well as clinical improvements in pain and function scores.
The proposed mechanism of action is clear: increased local oxygenation activates tenocytes, promotes the production of functional collagen and stimulates neovascularisation. In this way, hyperbaric oxygen therapy directly addresses key features of tendinopathy, namely inadequate vascularization and degenerative tissue changes.
The Role of Hyperbaric Oxygen Therapy
In athletes with tendinopathies, hyperbaric oxygen therapy may serve as a biologically regenerative treatment aimed at restoring vascularization and reactivating the production of functional collagen. Its purpose is therefore to address the underlying tissue changes rather than merely relieving symptoms.
When combined with an eccentric loading programme—the cornerstone of physiotherapy for tendinopathies—hyperbaric oxygen therapy may enhance the biological response to mechanical stimulation, allowing the tissue to remodel under more favorable metabolic conditions.
Its antioxidant effects may also reduce oxidative stress within degenerative tendon tissue, a factor that can perpetuate the condition and interfere with regeneration.
A typical treatment course consists of 20 to 35 sessions, always incorporated into a comprehensive sports medicine rehabilitation protocol.