Tendonitis

What is tendonitis?

Your tendons are strands of thick connective tissue between your muscles and bones that help you move as your muscles tighten and relax. Tendonitis or tendinopathy is where the tendon becomes inflamed or irritated, causing pain and tenderness around a joint and restricting your movement. 

Tendonitis can occur in any tendon in your body but is often experienced around the shoulders, elbows, wrists, knees and heels. It tends to happen due to repetitive strain or overuse in sports and is especially common in distance runners (Achilles tendonitis) and swimmers (rotator cuff tendonitis).

You can treat many cases of tendonitis with rest, ice, painkillers and physiotherapy. If your symptoms persist, you may need further tendonitis treatment such as steroid injections or surgery.  

What are the types of tendonitis?

Most types of tendonitis take their common names from activities and parts of the body where they happen. Some of the most common include: 

• Epicondylitis: This type affects the elbow. It's often known as tennis elbow when it affects the outside of the elbow or golfer's elbow when it occurs on the inside.
• Calcific tendonitis: This condition is caused by a build-up of calcium in the tendons. It usually affects the shoulder, where it's also known as rotator cuff tendonitis or swimmer's shoulder.
• Patellar tendonitis: This type causes pain between your kneecap and where the tendon attaches to your shinbone. It's also known as runner's or jumper's knee. 
• Achilles tendonitis: This type occurs due to overuse of your Achilles tendon, which is a band of tissue that connects your calf muscles to your heel bone. It's often caused by running or sports activity. 

Tendonitis vs tenosynovitis

Tenosynovitis is a condition linked to tendonitis that occurs when the lining of a tendon sheath becomes inflamed. A tendon sheath is a thin layer of tissue that encases a tendon and separates it from other surrounding tissue, allowing it to glide smoothly within the sheath. The tendon itself may or may not be inflamed at the same time. 

Common types of tenosynovitis are: 

• De Quervain's disease, affecting the sheaths surrounding the tendons that help move the thumb
• Trigger finger or thumb, which restricts extension and causes sudden locking or 'triggering'

What are the causes of tendonitis?

Tendonitis is a relatively common condition. Whether at work or enjoying hobbies, it's usually caused by repeated movements that put stress on your tendons over time, such as running, swinging a golf club or tennis racquet, and using tools or computers. 

As well as repetition, performing these movements incorrectly can overload your tendons. Some sudden, forceful movements can also be a cause of tendonitis. 

What are the symptoms of tendonitis?

You have tendons all over your body. Symptoms of tendonitis can vary depending on the tendon affected but commonly include:

• An ache or pain around the joint i.e. where a tendon attaches muscle to bone in your shoulder, elbow, knee or heel
• Stiffness and difficulty moving the joint, particularly first thing in the morning and after heavy exercise
• Swelling and tenderness, sometimes with redness
• A creaking or grating sensation when moving the tendon
  

Sudden pain and a popping or snapping sound can indicate that you've torn a tendon, which is known as a rupture. 

How to treat tendonitis yourself

For mild to moderate cases, you may be able to treat the problem yourself by:

• Resting the affected tendon for a few days and avoiding activities that make it worse. Once the initial pain reduces, keep moving the joint gently to prevent it from becoming stiff  
• Icing the tendon for around 15 minutes every two to three hours in the first few days 
• Supporting it with a bandage or brace that you take off before bed  
• Taking painkillers such as paracetamol or ibuprofen or applying ibuprofen gel to the affected area
  

Tendonitis screening and diagnosis 

Tendonitis can often be diagnosed through a physical exam. You will be examined focusing on the affected area and asked questions about how the pain is affecting you and your sports or exercise activities and other influencing factors that may have caused it. You'll be assessed to see how your movement may be contributing to the problem, sometimes through gait analysis which inspects how your body moves usually while walking or running.  

You may also undergo tests such as an ultrasound or MRI scan, which can rule out other conditions that could be causing your symptoms.

Potential treatment for tendonitis

As well as rest, ice and painkillers, rehabilitation such as physiotherapy is key for treating tendonitis when symptoms persist. 

Your tendons may need to be loaded in a certain way to improve the capacity of the tendon and the attached muscle to manage load. This is typically done in a graded fashion, with specific exercises to perform over several weeks. 

Physical therapy for tendonitis can also involve screening other joints for issues that may be causing you to move incorrectly, such as assessing shoulder mobility in cases of tennis elbow. You'll also be guided on how to return to activity gradually. 

If physical therapy isn't working, you may be recommended:

• Steroid injections known as corticosteroids that reduce pain and inflammation quickly in the short term. These injections aren't usually recommended as a long-term solution, as having repeated injections can weaken your tendons. 
• Platelet-rich plasma (PRP) injections, which are naturally occurring substances found in blood that can be injected into the injured area to promote healing. 
• Extracorporeal shockwave therapy, using a pneumatic device similar to a hard massage to stimulate tendon cells and promote pain relief
• A tendonitis operation to remove or repair damaged tissue. Tendon repair surgery is rarely needed and only recommended for severe symptoms where more conservative treatments aren't working.  

Preventing tendonitis

You can't always prevent tendonitis, but there are ways you can reduce the risk of injury, such as:

• Warming up your muscles before exercise and gently stretching afterwards
• Avoiding movements or activities that cause you pain where possible – for example, swapping running for cycling
• Moving correctly – for example, learning good form in sport or exercise and setting up your workspace correctly for your body and profession
• Taking regular breaks from repetitive movements 
• Not over exercising tired muscles
  

How long does tendonitis last? 

Most people who are diagnosed with tendonitis recover well with treatment and rest. 

It can take a few weeks to a couple of months to fully recover from tendonitis, depending on your injury's severity and how it's treated. Resting properly can help speed up your recovery time. Your specialist will tell you when it's safe to return to your regular activities, such as exercise and manual work.  

It's possible to suffer the same injury again if you put too much stress on the same tendons. If you have to perform repetitive movements for work or hobbies, a sport, exercise and musculoskeletal medicine specialist will be able to give you advice about avoiding repeat injuries.