Digital Exercise Interventions for Tendinopathy - A Systematic Review and Narrative Synthesis of Mobile and Web-app Delivered Rehabilitation

Abstract

Background Tendinopathy is common and burdensome, yet access to sustained, progressive exercise therapy is often limited by geography, time, and service capacity. Digital exercise interventions (DEIs) delivered through mobile or web applications may provide scalable rehabilitation by prescribing and progressing loading programmes with feedback, monitoring, and remote support.

Aims This review evaluated the impact of DEIs on pain and function in adults with tendon-related conditions.

Methods Medline, Embase, and Web of Science were searched between June and July 2025. Studies were eligible if exercise was prescribed and/or progressed via a mobile or web platform and clinical outcomes were reported. Post-surgical cohorts and studies without outcomes were excluded. Quality was appraised using Critical Appraisal Skills Programme (CASP) checklists. Findings were synthesised narratively with tendon-specific subgrouping and effect-direction plotting.

Results Nine studies addressed Achilles tendinopathy, hindfoot conditions (including plantar fascia), rotator cuff–related shoulder pain, elbow epicondylitis, and anterior knee pain (including patellar tendinopathy). Across conditions, DEIs produced meaningful short-term improvements in pain and function. For Achilles tendinopathy, remote care achieved pain improvements comparable to in-person visits, and web programmes reduced fear of movement more than comparators. For rotator cuff problems, adding video telerehabilitation to online exercise and education improved adherence, and several RCTs showed tele-rehab programmes superior to home exercise alone. One RCT in anterior knee pain found a digital therapeutic superior to standard care at 90 days. A large elbow cohort reported important disability and pain reductions with high engagement.

Conclusion Overall, DEIs often matched or outperformed conventional care in the short term. Synchronous videoconferencing tended to deliver greater gains in disability and quality of life than asynchronous or app-only approaches. Further research should test longer follow-up, compare delivery modes, and identify patient subgroups most likely to benefit. Evidence for hindfoot conditions was limited, but outcomes followed similar trends.