Tendonitis: Symptoms, Causes, Treatment and Recovery

What is tendonitis?

Tendons are bands of strong tissue that attach muscle to bone.² Tendonitis, also spelled tendinitis, means a painful, irritated tendon. It is an overuse injury, and it is different from a muscle strain or a ligament sprain.¹

Doctors increasingly use the word tendinopathy instead. It covers two overlapping problems:¹

• Tendinitis: inflammation of the tendon
• Tendinosis: breakdown of the tendon over time

The change of name reflects what researchers have found inside sore tendons. In long-standing cases the fibres that give a tendon its strength become disorganised, and there are changes in the blood vessels, nerves and cells within it.³ One influential model describes a continuum, from a tendon reacting to a sudden overload through to long-term structural change.⁴

Where does it happen?

Any tendon can be affected. The common sites are:^1,3

• Shoulder: the rotator cuff. See rotator cuff tears and shoulder pain
• Elbow: tennis elbow on the outside and golfer's elbow on the inside
• Wrist and thumb: de Quervain's tenosynovitis
• Hip and buttock: gluteal tendinopathy. See hip bursitis
• Knee: the patellar tendon below the kneecap
• Ankle and foot: the Achilles tendon, peroneal tendonitis and extensor tendonitis

Symptoms

• Pain where the tendon is, worse when you use it¹
• Swelling¹
• Stiffness and restricted movement at the nearby joint²
• Skin over the area that may feel warm²

What causes it?

Tendinopathy happens when a tendon is loaded beyond what it can cope with. That can be the same movement repeated over and over, or a sudden movement that puts too much stress on it.¹ Things that raise the risk include:^1,2

• Increasing the intensity of exercise over a short period
• Skipping a warm-up before sport or heavy lifting
• Unsuitable footwear
• Carrying extra weight, which adds load to the tendons of the legs
• Calcium deposits or bone spurs where the tendon attaches

Treatment

The first two days

Treat a newly sore tendon like any soft tissue injury: rest it, ice it, use a compression bandage and keep it raised. Avoid heat, alcohol, running and massage.¹

Then start moving

Do not rest completely for more than 48 hours. Being inactive for too long can slow recovery.¹ As symptoms ease, use the area as normally as you can. Trying to work through sharp pain delays healing, but so does keeping the area completely still.²

Loading programs

Exercise that loads the tendon in a planned, progressive way is the main treatment, usually guided by a physiotherapist.^1,3 Changes to sports technique and footwear can take stress off the tendon.¹

The research does not single out one best program. A major review described the effectiveness of the different exercise programs, other therapies and operations as still uncertain.³ For the Achilles tendon, a pooled analysis of trials did not show any one treatment to be better than another.⁶

Steroid injections

Injections are needed less commonly.¹ A review of 41 trials involving 2,672 people found that steroid injections reduced pain in the short term, but the effect reversed over the following months, with worse results than other treatments at 6 and 12 months.⁵

Surgery

Surgery is uncommon and kept for tendons that have not responded to other treatment.¹

How long does tendonitis take to heal?

Most cases recover completely without needing medical treatment.² Recovery varies a lot between people and between tendons. Some settle with simple measures, and some are slow to respond to anything.⁴

Early treatment leads to faster recovery. Ignoring the symptoms can make them worse, cause more damage to the tendon and lengthen recovery.¹

Preventing it

• Build up training gradually, and allow time to rest¹
• Warm up and cool down properly²
• If flat feet or leg alignment are straining your tendons, a podiatrist can fit shoe inserts²

When to see a doctor

• Symptoms have not improved after one or two weeks of looking after it yourself²
• The pain is severe, is getting worse, or is interfering with work, sport or daily life¹
• There is swelling, redness or heat around the area¹
• The skin changes colour, turning blue or white¹
• You develop a fever¹
• You felt a sudden snap or pop, or cannot use the limb normally

References

1. healthdirect. Tendinopathy.
2. Better Health Channel (Victorian Government). Tendonitis.
3. Millar NL, Silbernagel KG, Thorborg K, et al. Tendinopathy. Nat Rev Dis Primers. 2021;7(1):1.
4. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-16.
5. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-67.
6. Maetz R, Dubé MO, Tougas A, et al. Systematic Review and Meta-analyses of Randomized Controlled Trials Comparing Exercise Loading Protocols With Passive Treatment Modalities or Other Loading Protocols for the Management of Midportion Achilles Tendinopathy. Orthop J Sports Med. 2023;11(5):23259671231171178.