Tendinopathy

What is tendinopathy?

Tendinopathy is the broad term for any tendon condition that causes pain and swelling. Your tendons are rope-like tissues in your body that attach muscle to bone. When your muscles tighten and relax, your tendons and bones move. One example of a tendon is your Achilles tendon, which attaches your calf muscle to your heel bone and causes ankle movement. If you have pain and/or swelling in that area, you might have Achilles tendinopathy.

The pain from tendinopathy can interfere with your daily life. For example, it can keep you from playing sports and from doing housework. So, if you have pain or swelling, make sure to contact your healthcare provider for help.

Tendinopathy includes both tendinitis (tendonitis) and tendinosis.

Tendinitis

Tendinitis means inflammation of your tendon. It’s a painful injury that can either be short-term (acute) or long-term (chronic). You may develop tendinitis after a sudden injury from lifting a heavy weight or from repetitive activities that cause micro-tears in your tendon over time.

Tendinosis

Tendinosis is the breakdown (degeneration) of the collagen fibers in your tendon. It happens slowly and is often the result of tendon overuse.

What are the different tendon conditions?

Tendinopathies are tendon conditions that cause pain and swelling. Some of the most common tendinopathies that healthcare providers see include:

• Achilles tendinitis. Your Achilles is the strongest, largest tendon in your body.
• Patellar tendinitis. Your kneecap tendon (patellar tendon) connects the bottom of your kneecap (a bone) to the top of your shinbone (tibia). The patellar tendon is actually a ligament — it connects bone to bone instead of muscle to bone.
• Rotator cuff tendinitis. Your rotator cuff is a group of tendons and muscles that keep your shoulder joint stable.

Other tendinopathies include:

• De Quervain’s tendinosis (tenosynovitis), which affects your wrist and thumb.
• Golfer’s elbow (medial epicondylitis).
• Tennis elbow (lateral epicondylitis).

Who is at risk for tendinopathy?

Tendinopathy affects people of all ages, but some people are more likely than others to develop tendinopathy. Higher risk groups include:

• Athletes.
• People over 40 years old.
• People who do repetitive tasks.
• People who take certain medications.
• People with particular medical conditions.
• People with poor muscle strength.
• Women.

Just having increased risk doesn’t necessarily mean you’ll get tendinitis or tendinosis. Talk to your healthcare provider if you're concerned.

How common is tendinopathy?

In the general population, tendinopathy affects about 2% to 5% of people. It’s more common in athletes, though. For example, multiple studies have shown that each year around 10% of runners develop Achilles tendinopathy. Furthermore, roughly 50% of all sports injuries are tendon injuries.

What are the symptoms of tendinopathy?

You may have tendinopathy if you’re experiencing pain or tenderness with some or all of the following symptoms:

• Burning.
• Difficulty moving your joint.
• Feeling a crackling or grating sensation when you move your joint.
• Muscle weakness and loss of strength.
• Red, warm skin in the painful area. Please also note that red, warm skin sometimes indicates an infection. If you see this, please contact your healthcare provider.
• Stiffness.
• Swelling.

It might be helpful for you to make a list of your symptoms and keep a journal to track them. Your healthcare provider will want to know how long you’ve had the symptoms and their severity so they can make an accurate diagnosis.

What causes tendinopathy?

The exact cause of tendinopathy isn’t always clear. It’s often related to multiple factors. In addition to being in a higher risk group, other risk factors include:

• High-intensity training.
• Muscle imbalances.
• Incorrect training equipment or poor training surfaces.
• Lack of flexibility.
• Lack of strength.
• Too much weight on your tendon (from lifting something).

Tendon problems aren’t limited to athletes. As many as 30% of people with Achilles tendon injuries lead a sedentary (inactive) lifestyle. Experts theorize that a sedentary lifestyle contributes to poor blood circulation in the tendon. When someone has poor blood circulation and suddenly increases their activity, that can cause hypoxia (not enough oxygen in their tissues), impaired nutrition and weakened energy metabolism (metabolism is the process of changing food into energy). Those issues might contribute to events that lead to tendon degeneration.

Tendinopathy can turn chronic if minor injuries occur regularly and don’t heal completely. Repeated activities may cause collagen fibers to break down over time, leading to tendinosis.

Examples of repetitive tasks that can cause tendinosis include:

• Gardening.
• Lifting.
• Landscaping.
• Painting.
• Scrubbing.
• Shoveling.
• Sports.
• Typing.
• Woodworking.

Some medical conditions put you at a higher risk for tendinopathy, including:

• Dyslipidemia. Dyslipidemia is when your total cholesterol or triglycerides or both are too high.
• Gout.
• Obesity.
• Rheumatoid arthritis.
• Type 2 diabetes.

Medications that increase your risk of tendinopathy include:

• Fluoroquinolones (a class of antibiotics).
• Glucocorticoids (medicines that fight inflammation). Glucocorticoids are a type of medicine, as well as a hormone in your body. If you have too much of the hormone, that can cause insulin resistance, dyslipidemia and Type 2 diabetes. All three metabolic states put you at a higher risk for tendinopathy.

Common sports associated with tendinopathy include:

• Baseball.
• Basketball.
• Golf.
• Skiing.
• Soccer.
• Swimming.
• Tennis.

How is tendinopathy diagnosed?

Your healthcare provider should go through two steps when you see them about your symptoms: they’ll discuss your history and perform a physical examination. When you talk about your history, your healthcare provider should address:

• The location of your pain.
• The severity of your pain. They’ll ask you to rate your pain on a scale.
• The type of pain (burning, dull, sharp).
• How long you’ve had the symptoms.

During the physical exam, your healthcare provider might:

• Look for redness.
• Look for swelling.
• Test your range of motion (how far you can stretch or move part of your body).
• Touch certain areas to see if you feel tenderness.

Your healthcare provider might diagnose you with tendinopathy based on reported symptoms and the physical exam or, if they need more information, they might order an imaging test such as:

• Ultrasound. An ultrasound reveals changes in your tendon such as thickness, length, stiffness, disorganized and misaligned tendon fibers and tears.
• MRI. Magnetic resonance imaging (MRI) shows the general health or injuries in your tendon.

What questions might my healthcare provider ask to diagnose tendinopathy?

Your healthcare provider might ask questions such as:

• What are your symptoms?
• Did the symptoms come on suddenly or happen gradually?
• Do you play any sports?
• Have you tried any at-home treatments like icing?
• How long have you had these symptoms?
• How severe is your pain?
• What are your daily activities?
• What medications do you take?

How is tendinopathy treated?

The treatment for your tendinopathy depends on the type you have. The treatments for tendinosis aren’t the same as the treatments for tendinitis. Treatment also depends on which tendon is bothering you. The common treatments for tendinosis include:

• Rest. If you do repetitive tasks at work, try taking a short break every 15 minutes. And try resting for five minutes every 30 minutes.
• Ice. Apply an ice pack or cold compress for 20 minutes every two hours. Don’t put the ice directly on your skin.
• Eccentric strengthening. Eccentric strengthening involves tightening your muscle while you hold something heavy. For example, when you stretch out a muscle like your bicep (a large muscle in your upper arm) while holding a dumbbell (weight) in your hand. Such movement helps with tendon strength and helps stimulate the production of collagen. Experts recommend that people with tendinosis practice eccentric strengthening every day. Talk to your healthcare provider or physical therapist to find out exactly what you should do.
• Stretching. Stretching can help your tendinopathy in several ways. It keeps you flexible, increases circulation (helps you heal) and reduces tendon tension (tightness).
• Massage. Deep-friction massage applied to your tendon can generate new collagen fibers, reduce your pain and increase your strength.
• Hyperthermia. Hyperthermia is when your body overheats. It’s also a type of treatment for tendinopathy. A heating system increases your temperature to increase blood flow. Blood flow can stimulate healing for your tendinopathy.
• Supplements. Vitamin C, manganese, zinc, vitamin B6 and vitamin E are all connected to tendon health. Talk with your healthcare provider about dosages so you don’t take too much. You should always check with your healthcare provider before using any supplements.

Researchers tried other treatments, including low-level laser therapy, iontophoresis, phonophoresis and therapeutic ultrasound. Unfortunately, researchers found very little proof that these treatments help with tendinosis.

Common treatments for tendinitis include:

• Rest.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs like ibuprofen (Advil®, Motrin®) can help with inflammation and swelling.
• Corticosteroid injections. These can help acutely (short-term) with the swelling and pain of tendinitis, but they often don't work longer term or in the case of tendinosis.
• Orthotics, splints and braces. Orthotics and braces such as shoe orthotics and elbow bands protect your tendons and lessen the loads they carry.
• Physical therapy. Physical therapy can help teach you how to properly stretch and gradually strengthen your muscles.
• Massage. By stimulating nerve endings and pressure points, massage promotes healing and relaxation and can reduce pain.
• Acupuncture. In this treatment, a provider places very thin steel needles in the skin to stimulate specific points in the body.
• Platelet-rich plasma. Your provider may suggest an injection of platelet-rich plasma. Platelets are cell fragments found in blood that, when injected, can encourage healing. Most insurances don’t cover the cost of this therapy.
• Extracorporeal shockwave therapy (ESWT). In this therapy, your healthcare provider uses a handheld device to deliver high-energy sound waves that can stimulate blood flow to the area and encourage healing.
• Minimally invasive tendon debridement. If other, more conservative treatments fail, your healthcare provider may consider a minimally invasive surgery to remove the damaged tissue.

Your healthcare provider might consider surgery if none of the nonsurgical treatments work. They’ll likely have you try the nonsurgical treatments for about six months and, if they don’t work, then they’ll consider surgery.

Do I need to see a specialist?

Yes, you may need to see a specialist. Different healthcare providers specialize in muscle and bone problems, and you should ask your healthcare provider which type you should see.

How long does it take to recover from tendinopathy?

Recovery time for tendinitis can take as little as two days (if it’s an acute injury) and as long as six weeks. Tendinosis usually takes about two to six months.

How can I reduce my risk of tendinopathy?

You can't prevent tendinopathy altogether. For example, accidents can happen to you while you’re playing or working. But, you can take some steps to reduce your risk of tendinopathy.

To reduce your risk of tendinopathy, work with a trainer or coach. A change in how you play or a different way to stretch could help the same tendons.

What’s the prognosis/outlook for tendinopathy?

The prognosis for people with tendinopathy is usually very good. Most people recover from tendinopathy without surgery.

Can tendinopathy come back after treatment?

Yes, tendinopathy can return if you have another injury or continue the same repetitive tasks as before. Talk to your healthcare provider about ways to help reduce the risk of your specific tendinopathy coming back after treatment (recurring).

When should I contact my healthcare provider?

You might want to see your healthcare provider if you have an injury and experience symptoms of tendinopathy. You should also see your healthcare provider if you slowly get the symptoms of tendinopathy over a few weeks.

When should I go to the emergency department?

You might want to go to the emergency department if you feel sudden, sharp pain, especially when you’re playing a sport or exercising.

What questions should I ask my healthcare provider about tendinopathy?

• What condition do I have? How did I get it?
• What’s the best treatment for me?
• Do I need surgery?
• Do I need to see a physical therapist?
• When can I get back to my usual activities?

A note from Cleveland Clinic

Tendinopathy is a broad term for conditions of the tendon that cause swelling and pain. Tendon conditions are painful. They can restrict your movements and bench you not just from the game, but also from your everyday activities. See your healthcare provider if you have symptoms of tendinopathy. There are treatments available and several steps you can take by yourself to help your healing process. The faster you get help, the faster you’ll feel better.