It is one of the most common consultations at the clinic: a tendon that started to bother six months ago, settled with rest and hurt again a week after returning to activity. The patient has tried ice, anti-inflammatories, stretching and several rounds of massage. Nothing has changed for good.
The reason is usually the same: an inflammation that no longer exists is being treated.
Tendinitis isn't the same as tendinopathy
The word "tendinitis" implies inflammation, and inflammation does exist, but only in the first days after overload. After a few weeks the process changes nature: collagen fibres lose their alignment, disorganised tissue appears, new blood vessels and nerve endings grow where they shouldn't, and the tendon becomes mechanically weaker. That is called tendinopathy, and it is a problem of degeneration, not inflammation.
The practical consequence: an anti-inflammatory acts on a process that has already died down. It may ease the pain for a few days, but it doesn't reorganise the collagen or restore the tendon's strength.
Why rest isn't enough either
The tendon adapts to load. When load is removed completely, the tissue weakens even further, so when activity resumes the same movement that was tolerated before hurts again. This is the cycle behind relapses: rest, apparent improvement, return, relapse.
A degenerated tendon needs two things: a stimulus that reactivates repair in the damaged area, and then progressive load that rebuilds the structure. EPI covers the first; therapeutic exercise, the second.
What exactly EPI is
Intratissue percutaneous electrolysis involves applying a low-intensity galvanic current through a fine needle placed inside the degenerated tissue. The needle isn't placed blindly: it is guided by real-time ultrasound, so the physiotherapist sees the damaged area on the screen and positions the tip exactly there.
Ultrasound locates the injury
Before inserting the needle, the image shows which part of the tendon is degenerated, where there is neovascularisation and how much thickness is affected. Without that image, the technique loses its main advantage.
The current only acts where it is applied
The effect is very localised, within millimetres of the needle tip. The surrounding healthy tissue is not affected.
The stimulus restarts repair
The current causes a controlled chemical reaction that removes degenerated tissue and triggers a new, orderly inflammatory response, the one the body needed to repair and which had stalled.
What happens after the session is what decides the result
Here is the most common misunderstanding. EPI is not a stand-alone treatment that is applied and fixes everything. It creates the biological window for the tendon to repair; what determines the quality of the new tissue is the load applied to it in the following weeks.
That is why each session comes with a specific, progressive exercise programme. Collagen aligns in the direction it is asked to work, so exercise isn't an add-on: it is what turns repair tissue into a functional tendon.
Tendinopathies where we use it most
Patellar tendinopathy
Pain at the front of the knee, typical of jumping sports and changes of direction.
Achilles tendinopathy
Very common in runners, both in the body of the tendon and where it attaches to the heel.
Lateral epicondylalgia (tennis elbow)
Pain on the outside of the elbow from repetitive gripping, in sport or at work.
Rotator cuff tendinopathy
Shoulder pain when raising the arm, common in overhead work and throwing sports.
Plantar fasciitis and fasciopathy
Pain in the sole of the foot, especially with the first steps in the morning.
Does it hurt?
During application you feel a localised cramp lasting a few seconds, and in the following hours some discomfort in the area is normal, similar to intense muscle soreness. It usually settles in one or two days. Intensity is adjusted at each session, and the usual number of sessions is between three and six, one week apart.
When it makes sense to consider it
When pain has lasted more than three months, when there have been several relapses on returning to activity, or when ultrasound shows structural degeneration of the tendon. If the injury is recent and the process is still inflammatory, there are other options first: at the initial assessment we decide with the ultrasound in front of us, not by default.
