Tendinopathy is not only induced by mechanical loading but is also related to metabolic noxae. Hypoxia, which may be induced by conditions such as diabetes, obesity and sedentary lifestyle, has been shown to play a role in early tendinopathy. Ultrasound-guided galvanic electrolysis reduces inflammation and promotes collagen synthesis and may be combined with supplementation with nutraceuticals for better tendinopathy treatment. This article provides an update of the multimodal approach to the management of tendinopathy as discussed during the 2022 Italian Society of Muscles, Ligaments and Tendons (I.S.Mu.L.T.) Congress. Prior to the meeting, a search was conducted in PubMed/Medline with crossed keywords relative to the subject. The recommendations of the meeting were that long-term management of tendinopathy should be based on the combination of ultrasound-guided galvanic electrolysis with therapeutic exercise in a rehabilitation plan associated with dietary supplementation with nitric oxide, collagen I, methylsulfonylmethane, and vitamins D and C.