How Do I Know If I Have Tendonitis?
Key takeaways:
Tendon injuries are common in active people, whether for work or play.
The main symptom is pain in the affected tendon (usually near a joint) that is worse with activity.
Treatment involves resting from the offending activity and doing specific exercises.
If you’re active in sports, exercise, or physical labor of any kind, you have probably experienced aches and pains in and around your joints. The musculoskeletal system — muscles, bones, and their supporting tissues — is at risk for injury when we overdo it with activities, especially repetitive ones. One common example of this is tendonitis (also called tendinopathy).
What is tendonitis?
Tendonitis is a term that refers to painful inflammation of a tendon. Tendon injuries can happen at any age, but it is more common the older we get. Some experts estimate that 1% to 2% of adults will have a lower extremity tendon problem in their lifetime.
Although we have hundreds of tendons in the body, those in the arms and legs near joints tend to be injured most. The tendons of the following muscles are commonly affected:
Achilles (heel)
Posterior tibialis (ankle)
Patellar (knee)
Gluteal muscles (hip)
Wrist extensor tendons (elbow, also called “tennis elbow”)
Rotator cuff (shoulder)
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What is the difference between tendonitis, tendinosis, and tendinopathy?
Tendonitis is inflammation of a tendon, which causes swelling and pain. Tendonitis is actually a bit of a misnomer. That’s because the “-itis” at the end of the word implies inflammation, which might not actually be present.
There are various theories about how tendon problems develop. But it’s now widely accepted that most cases of tendon problems are due to damage to the structure of the tendon, not only inflammation. With overuse, small tears occur in the tendon. If it’s not allowed to heal properly, the fibers that make up the tendon become weak and disorganized. This is tendinosis. When this ongoing tendon structure problem causes pain and impaired function, it’s tendinopathy.
It’s true that some tendon problems are actually tendonitis. If there is swelling around the area where you have pain, there is probably a bit of inflammation. But if your pain has been going on for weeks, it’s likely that the tendon has been damaged. This difference is important, because it affects how it’s treated.
What risk factors contribute to the development of tendon problems?
Research suggests some people may be more likely to have tendon problems. Examples include people who:
Play sports
Have jobs that require repetitive activities, such as construction or assembly line workers, musicians, and cooks
Have medical conditions, such as diabetes or obesity
Have taken medications, such as antibiotics called fluoroquinolones or hormone replacement therapy
Several other factors can increase your risk of tendon injury. Some are related to your body and mechanics, such as:
Muscle imbalance
Limb misalignment (such as flat feet or bowed legs)
Previous tendon injury
Others are related to participation in sports or other physical activities, such as:
Sudden or dramatic increase in activity
Activity conditions (surfaces or equipment)
Returning to activity too quickly after injury
How are tendonitis and tendinopathy diagnosed?
Tendon problems do not require any specific test for diagnosis. They can usually be diagnosed based on your symptoms and a physical examination. It helps to see a healthcare provider who has specialized training in musculoskeletal problems, such as a sports medicine physician or orthopedist.
In some cases, imaging tests can be helpful, especially if your pain has continued for weeks despite treatment. These tests may include ultrasound or magnetic resonance imaging (MRI). Imaging tests may also help rule out other conditions if the cause is not clear.
How do you treat tendonitis or tendinosis?
Activity modifications
The first step in treatment is to identify any activity that might be causing you problems and take a break from it. For example, if you’re a runner, this means switching to other cardio activities or at least decreasing your mileage. If your injury is related to your work, modifications should be made. Ask your healthcare provider for documentation if needed.
Anti-inflammatory treatment
Ice and non-steroidal anti-inflammatory medications are helpful for tendonitis. They can help relieve some of the pain and swelling from inflammation.
Steroid injections were commonly recommended for tendon problems in the past, but this has changed in recent years. While they can provide some short-term pain relief, it usually does not last. Further, steroid injections have been shown to inhibit tendon healing. For these reasons, they are no longer recommended.
Exercises
Tendon-loading exercises are the most effective treatment for tendinopathy. This means doing slow, controlled movements that work the muscle and tendon. These exercises help the tendon heal itself and restructure properly.
Depending on which tendon is injured, and your level of comfort, you may be able to do exercises on your own. Many providers have handouts of recommended exercises to do. However, in many cases, working with a physical therapist is a good idea. They can show you what exercises to do and how to do them safely. It’s important to prevent reinjuring yourself while healing.
Topical nitroglycerin
Nitroglycerin patches placed on the skin over the affected tendon can improve pain and function. They deliver nitric oxide to the damaged area, which is thought to help with tendon healing and restructuring.
Other
If you’ve tried everything with no relief, it may be time to visit a musculoskeletal expert for other options. Other procedures (such as tenotomy or platelet-rich plasma injections) may be helpful, but standard protocols for them have not yet been established. They are also usually expensive.
Last, surgery is an option if other treatments have been exhausted. It is usually saved for last, because there are more risks with surgery, and evidence to support it is not very strong.
Can tendonitis go away on its own?
If the offending activity continues, tendonitis and tendinopathy are unlikely to go away on their own. These injuries can be frustrating, to say the least. It’s important to allow time for rest and healing and be consistent with your exercises.
The bottom line
Tendonitis and tendinopathy are common tendon injuries, especially in active people. Because they are related to overuse, it’s important to take a break from offending activities. Strengthening exercises are also helpful. When in doubt, it’s a good idea to visit your healthcare provider or a physical therapy for guidance and treatment options.
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