Many people are familiar with “tendinitis,” a term often used to describe a painful tendon. However, the scientific understanding of tendon injuries has evolved. The broader, more accurate term for most chronic tendon problems is now “tendinopathy,” which reflects a deeper knowledge of what happens inside an injured tendon.
The term tendinitis, with its “-itis” suffix, implies the primary issue is inflammation. While inflammation can be present in the very early stages of a tendon injury, it is now understood to be largely absent in long-term cases. Instead, the problem lies within the structure of the tendon itself.
Tendinopathy describes a condition of cellular-level breakdown and disorganization. Tendons are made of strong, organized collagen fibers that connect muscle to bone. In tendinopathy, these collagen fibers become weak, disorganized, and can develop tiny tears, a process called degeneration. This updated understanding changes the focus of treatment from simply reducing inflammation to encouraging repair and remodeling of the tendon tissue.
Causes and Common Locations
The fundamental cause of tendinopathy is when a tendon is subjected to a load that exceeds its capacity to adapt. This overload can happen through repetitive, lower-intensity actions over a long period or from a sudden, sharp increase in activity. Activities like running or typing can lead to overuse injuries if the tendon isn’t given enough recovery time. A sudden spike, such as a weekend warrior engaging in intense sport without prior conditioning, can also trigger the condition.
Beyond simple overuse, several other factors can contribute to the development of tendinopathy. Poor biomechanics, such as improper technique in sports or an inefficient running gait, can place excessive stress on specific tendons. Age is another factor, as tendons naturally lose some of their elasticity and ability to heal over time. Certain systemic conditions, including diabetes and inflammatory arthritis, can also alter tendon tissue and make it more susceptible to injury.
This condition can affect any tendon, but certain areas are particularly vulnerable due to the demands placed on them. In the shoulder, tendinopathy frequently affects the rotator cuff tendons from overhead activities. The elbow is another common site, with lateral epicondylopathy (tennis elbow) affecting the outer tendons and medial epicondylopathy (golfer’s elbow) affecting the inner ones. In the lower body, the patellar tendon (jumper’s knee) and the Achilles tendon are frequently impacted, especially in athletes who do a lot of running and jumping.
Recognizing the Symptoms
The most prominent symptom of tendinopathy is localized pain that is directly related to activity. The pain worsens when you use the affected tendon and often subsides with rest. For example, someone with Achilles tendinopathy will feel pain when walking or running, which eases when they sit down. This pain can range from a dull ache to a sharp, burning sensation.
Another common feature is stiffness in the affected area, particularly in the morning or after long periods of inactivity. This morning stiffness can make the first few movements of the day difficult and painful. It often eases as the area warms up with gentle movement.
Upon physical touch, the affected tendon is usually tender, and pressing on the specific spot will often reproduce the pain. In some chronic cases, the tendon itself might feel thickened or have a palpable nodule, a sign of degenerative changes. The area might also feel warm or appear slightly swollen, though significant swelling is less common than in acute inflammatory conditions.
The Diagnostic Process
Diagnosing tendinopathy begins with a thorough discussion of your medical history and symptoms with a healthcare provider. The clinician will want to know when the pain started, what activities make it worse or better, and if there have been any recent changes in your activity levels. This conversation helps build a picture of how the injury developed.
Following the history, a detailed physical examination is performed. The provider will palpate the area to pinpoint the exact location of tenderness along the tendon. They will also assess the joint’s range of motion and test the strength of the associated muscles, often by asking you to move against resistance.
While diagnosis is often made based on the history and physical exam alone, imaging tests are sometimes used. An ultrasound or an MRI can provide a detailed look at the tendon’s structure, revealing thickening or tears. These imaging tests are not always necessary but are used to rule out other problems, such as a complete tendon rupture, if symptoms are unusual or not improving with initial treatment.
Rehabilitation and Management Approaches
The foundation of modern tendinopathy treatment is a progressive exercise program, moving away from the outdated advice of prolonged rest. The goal is to improve the tendon’s ability to handle load through targeted exercises. This process starts with “load management,” which involves reducing or modifying activities that aggravate the pain but not ceasing all movement, as complete rest can weaken the tendon.
Rehabilitation often begins with isometric exercises, where the muscle is contracted without moving the joint. For example, a person with patellar tendinopathy might perform a wall sit. These exercises, which involve holding a contraction for 30-45 seconds for several repetitions, can have a pain-relieving effect and are a safe way to start loading the tendon.
As the pain subsides, the program progresses to exercises that move the tendon through its range of motion under load. Two effective methods are eccentric exercises and heavy slow resistance (HSR) training. Eccentric exercises focus on the lengthening phase of a muscle contraction, such as slowly lowering the heel off a step for Achilles tendinopathy. HSR involves performing traditional strength exercises, like squats or leg presses, very slowly with a substantial weight. Both approaches stimulate collagen remodeling and improve the tendon’s structure and strength.
While therapeutic exercise is the main component of recovery, other treatments may be used to support the process. Manual therapy performed by a physical therapist can help improve mobility and reduce pain. Extracorporeal shockwave therapy is another option for chronic cases. In contrast, corticosteroid injections are used less frequently, as they may provide short-term pain relief but can potentially weaken the tendon in the long run.