Tendonitis

Tendonitis, tendinitis and tendinopathy

Tendonitis and tendinitis are two spellings of the same word; see also our page on tendinitis. The "-itis" suggests inflammation, but in most long-lasting tendon problems the tendon shows degeneration and disorganized collagen rather than classic inflammation. Doctors therefore increasingly use tendinopathy, an umbrella term for painful tendon conditions. Short-term overload can cause a reactive, more inflamed tendon; repeated overload leads to chronic tendinopathy.

This matters for treatment: chronic tendinopathy responds best to progressive loading exercises, not prolonged rest or anti-inflammatories alone.

Common types of tendonitis

Causes and risk factors

• repetitive movements at work, in sports or hobbies
• sudden increase in training volume or intensity
• poor technique or equipment
• age: tendons become less elastic after 40
• medical conditions: diabetes, rheumatoid arthritis, gout, high cholesterol, obesity
• medicines: fluoroquinolone antibiotics, which can cause tendon pain and rupture, particularly in people over 60 or on steroids
• muscle weakness or tightness

Symptoms

• pain at or near a joint, worse with activity or loading the tendon
• tenderness when the tendon is pressed
• stiffness, especially in the morning or after rest
• mild swelling or thickening
• a creaking or grating feeling (crepitus) in some cases
• pain that may warm up with activity, then return afterward

Diagnosis

Tendonitis is usually diagnosed by history and examination: locating tenderness and testing which movements reproduce pain. Imaging is not always needed:

• ultrasound shows tendon thickening, tears and blood flow changes
• MRI for suspected tears or unclear diagnoses
• X-ray for calcific deposits or bone spurs
• blood tests if inflammatory arthritis or gout is suspected

Treatment

Load management and relative rest

Reduce activities that aggravate the tendon, without stopping all movement. Pain during exercise up to about 3 to 4 out of 10 that settles by the next day is generally acceptable.

Exercise therapy

The most effective long-term treatment:

• isometric exercises (holding a contraction) to reduce pain early
• progressive strengthening, including eccentric and heavy slow resistance exercises
• gradual return to sport-specific loads

A physical therapist can design a program, typically over 6 to 12 weeks or more.

Pain relief

• ice for 10 to 15 minutes after activity
• acetaminophen (paracetamol), or short courses of NSAIDs such as ibuprofen or topical NSAID gels at the label dose; avoid NSAIDs with kidney disease, stomach ulcers or blood thinners
• braces or straps, such as a counterforce strap for tennis elbow or a thumb splint for De Quervain's

Injections and procedures

• corticosteroid injections give short-term relief for some types (shoulder, De Quervain's) but may weaken tendons and are avoided around the Achilles and patellar tendons
• shockwave therapy for chronic Achilles, patellar, plantar and calcific shoulder problems
• platelet-rich plasma has mixed evidence
• surgery for tendon tears, calcific deposits or cases failing 6 to 12 months of treatment

Prevention

• increase training gradually, by roughly 10 percent a week
• warm up and use proper technique
• strengthen the muscles around commonly affected joints
• vary repetitive tasks and take breaks
• use correct equipment, such as racquet grip size and running shoes

Frequently asked questions

What is tendonitis?

Tendonitis is pain and irritation in a tendon, the cord that attaches muscle to bone, usually from overuse or a sudden increase in activity. It commonly affects the shoulder, elbow, wrist, knee and heel. Many long-lasting cases are better described as tendinopathy.

How long does tendonitis take to heal?

Mild tendonitis often improves within 2 to 6 weeks. Chronic tendinopathy can take 3 to 6 months or longer of progressive exercise to resolve. Returning to full activity too soon can cause flare-ups.

What is the fastest way to heal tendonitis?

Reduce aggravating activity, use ice and short-term pain relief, then start isometric and progressive strengthening exercises early. Complete rest for long periods weakens tendons. A physical therapist can speed recovery with a structured plan.

Should I rest or exercise with tendonitis?

Both, in balance. Rest from activities that provoke significant pain, but keep the tendon moving and progressively loaded with controlled exercises. Mild discomfort during exercise is acceptable if it settles within 24 hours.

Is tendonitis the same as bursitis?

No. Tendonitis affects tendons, while bursitis is inflammation of a bursa, a small fluid-filled cushion near a joint. They often occur together, for example in the shoulder and hip, and are treated in similar ways.