Tendinopathy

What is tendinopathy?

Tendinopathy is any condition that affects a tendon, making it painful to use and reducing its functionality. Tendons are rope-like connective tissues that attach muscles to bones. Most people injure their tendons by overusing them — although other factors can contribute to weakening of your tendons. Tendinopathy can begin when a tendon injury can’t heal. Eventually, destructive changes begin to occur.

Types of tendinopathy

Tendinitis and tendinosis are two different types of tendinopathy. While they often begin in a similar way, they affect your tendons by different processes. They also have different treatment protocols.

Tendinitis is inflammation in your tendon. It’s usually an acute response to an injury. But it can become chronic if the injury doesn’t heal. If inflammation lasts too long, it can be destructive.

Chronic tendinitis can lead to:

• Scarring and micro-tearing
• Calcium deposits
• Tendinosis

Tendinosis is a breakdown of the collagen in your tendon, which makes it lose its strength and elasticity. It happens separately from inflammation. The process is progressive and lasting.

Untreated tendinosis can lead to:

• Muscle atrophy
• Tendon rupture
• Disability

Tendinopathy in different tendons

When symptoms first develop, most people don’t know what type of tendinopathy they have — only where it hurts. You might simply say that you have “shoulder tendinopathy” or “ankle tendinopathy.”

Tendinopathy is most common in your:

• Heel (Achilles tendon)
• Foot (posterior tibial tendon)
• Ankle (peroneal tendon)
• Knee (patellar tendon)
• Shoulder (supraspinatus tendon or rotator cuff)
• Elbow (lateral extensor or medial flexor tendons)
• Wrist (abductor and extensor tendons)

As many tendon injuries begin as sports injuries, it’s common to refer to a sore tendon by the name of the sport that can cause it. However, you may still develop this tendon injury without playing a sport.

Examples include:

• Tennis elbow
• Golfer’s elbow
• Swimmer’s shoulder
• Jumper’s knee

What are the symptoms of tendinopathy?

Tendinopathy is characterized by:

• Chronic tendon pain
• Reduced exercise tolerance
• Reduced functionality in the tendon

Depending on the type, it may also cause:

• Swelling, heat and discoloration
• Stiffness and reduced range of motion
• A crackling or grating sensation when the tendon moves

What causes tendinopathy?

It’s not always clear how tendinopathy develops, but it often starts with overusing your tendon. How much force your tendon can tolerate may differ from the next person. Athletes can strain their tendons by overtraining. People who aren’t regularly active can strain a tendon by suddenly increasing their activity. Any task repeated too often without enough rest in between can cause a repetitive strain injury.

Examples of repetitive tasks include:

• Scrubbing
• Typing
• Gardening
• Sewing
• Woodworking and carpentry
• Weight training

Factors that may contribute to straining your tendon include:

• High-intensity training
• Poor ergonomics or equipment
• Lack of flexibility
• Lack of strength
• Muscle imbalances
• Posture or gait abnormalities
• Too much weight on your tendon
• Certain autoimmune diseases

In addition, some medications can cause tendon damage as a side effect, including:

• Fluoroquinolones (a type of antibiotic)
• Corticosteroids
• Statins

When you strain your tendon, small tears in the fibers can form. Tendons are strong, but when they tear, they’re slow to heal. Acute inflammation (tendinitis) is your body’s way of starting the healing process. But if your tendon doesn’t get the rest it needs to heal, chronic tendinopathy can set in. Tendinitis might continue long-term, or tendinosis might begin the process of remodeling your tendon.

How is tendinopathy diagnosed?

If you have tendon pain with activity that lasts for several months, you have tendinopathy. But it’s important to find out what kind you have. A healthcare provider can diagnose your tendinopathy with a physical exam and imaging studies. They’ll ask about your symptoms, activities and any recent changes. They’ll examine your tendon and may follow up with imaging to look for signs of tissue changes.

How do healthcare providers treat tendinopathy?

Treatment for different types of tendinopathy can vary, which is why it’s important to get an accurate diagnosis. Treatment can also vary by how long you’ve had tendinopathy and how far it’s progressed. Healthcare providers usually begin with conservative therapies, like rest, ice, anti-inflammatory medications and physical therapy. If these don’t help enough, they may suggest other interventions, such as:

• Therapeutic injections
• Minimally invasive tendon debridement
• Extracorporeal shockwave therapy (ESWT)
• Surgery

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.

How long does it take to recover from tendinopathy?

Recovery from acute tendinitis only takes a few days to weeks, but recovery from chronic tendinitis can take up to six weeks. Tendinosis recovery can take much longer — between two and six months. Recovery depends on being able to relieve the strain on your tendon long enough for healing to take place. Follow your healthcare provider’s advice on rest and exercise to ensure a smooth recovery.

What should I do and not do with tendinopathy?

If you have tendinopathy:

• Don’t: Ignore your pain. You might be used to a certain level of soreness if you’re used to training or doing repetitive tasks. But if it persists or gets worse, see a healthcare provider.
• Do: Get a specific diagnosis. Tendinitis and tendinosis are not the same. Knowing what you’re dealing with will help you understand your treatment plan and what to expect from recovery.
• Don’t: Be impatient. Your tendon needs time to heal. Don’t try to use it again until your healthcare provider says it’s OK. Trying to cut your recovery time will only prolong it in the end.
• Do: Practice your physical therapy. As important as it is to rest your tendon, it’s equally important to rehabilitate the muscles connected to your tendon, and later, the tendon itself.
• Don’t: Lose heart. If conservative therapy doesn’t work, there are a variety of other treatments to try. Most people won’t need surgery for tendinopathy. But if you do, surgery can help.
• Do: Make some long-term changes. Now that you know how tendinopathy happened to you, try to avoid it in the future by adjusting your routine, technique, equipment or other factors.