Tendonitis (Tendinitis) Latest Facts: Causes, Types, Symptoms, Treatment and Prevention

Tendonitis is usually a transient but particularly annoying musculoskeletal disorder caused by severe strain on the tendons. It mainly affects athletes and women, but can also occur in workers who perform repetitive motions. Tendonitis often takes time to heal, so it is important to be aware of preventive measures and react to early signs to reduce the risk of complications. In this article, Gilmore Health explains the causes, symptoms, and treatments that need to be implemented to properly treat tendonitis.

Achilles Tendon

Achilles Tendon

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What is a tendon?

Tendons situated at the ends of muscles transfer muscle force to the bones to enable all movements of the body. They are bundles of strong, smooth fibers surrounded by a membrane called the epitenon. They are composed of 70% water, collagen, glycoproteins, and proteoglycans. They have very little vascularity and are resistant to tension while being elastic. Some tendons, especially those that go over bones, are surrounded by a protective sac (paratenon) that produces a lubricating fluid, synovium, whose function is to make it easier for the tendons to glide during movement. When worn, and in the absence of tendinopathy, new fibers replace the old ones in tendons.

What causes tendonitis?

Due to the misuse of language, we tend to refer to all tendon issues as tendonitis. However, these pains should be classified as tendinopathies. In fact, while tendonitis is caused by inflammation, tendinopathy is more often associated with degeneration of non-inflammatory origin. This is called tendinosis or overuse tendinopathy.

Athletic causes

Exercise is the main cause of tendonitis. The tendon can become inflamed after an effort that has strained it. Inadequate warm-up before the effort is also a frequent cause of tendonitis, as it deprives the tendons of a preparation adapted to the effort. Trying a new sport also carries the risk of tendonitis. Finally, special attention should be paid to equipment, especially footwear, and ensure that all equipment is suitable for the sport being played, otherwise, tendons can be weakened.

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Repetitive movements

In addition to sports, repetitive movements and postures that put a strain on the tendons can lead to tendonitis. This is the case for people who work on production lines, bus drivers, cashiers, maintenance workers, construction workers, etc. Repeating the same movements every day puts excessive strain on the tendons and promotes inflammation, which is the cause of tendonitis, and degeneration of the collagen fibers.

Personal risk factors

Some people are more susceptible than others to developing tendonitis because of their lifestyle or health conditions. Thus, smoking, a sedentary lifestyle, and age are favorable factors. Taking certain medications can also weaken tendons, as can certain diseases. Dupuytren’s disease, for example, causes the tissue under the skin of the palm to thicken and contract. The tendons attached to the fingers can no longer move freely, which can lead to degeneration of the tendons.

The most common types of tendonitis

All tendons can be affected by tendonitis. The most commonly seen types of tendonitis are:

  • Shoulder tendonitis, also known as rotator cuff tendonitis or supraspinatus tendonitis.
  • Tendonitis of the elbow, also known as epicondylitis or tennis elbow (as it is very common among tennis players).
  • Achilles tendonitis or calcaneal tendonitis.
  • Patellar tendonitis.
  • Windshield wiper syndrome (runner’s knee).
  • De Quervain’s tendonitis (tendons of the thumb attached to the wrist).
  • Pubalgia (adductor tendonitis).

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Symptoms of tendonitis

In most cases, tendonitis starts gradually. An initially unknown pain manifests itself as a more or less intense localized pain. At first, the pain is only felt after and during the effort that puts pressure on the tendon concerned. If left untreated, it becomes ubiquitous, even at rest, and can become more pronounced when the area is touched.

In some people, the pain of tendonitis is associated with loss of strength, warming, and/or swelling in the affected part of the body. Twitching and redness of the skin may also occur. The Blazina classification can be used to distinguish between the different stages of tendonitis:

  • Stage 1: post-exertional pain that resolves at rest
  • Stage 2: pain during exercise
  • Stage 3: persistent pain that makes daily life and sports difficult
  • Stage 4: tendon rupture.

The doctor will assess the severity of the tendonitis based on an analysis of the clinical signs. Additional tests, such as ultrasound or MRI, may also be done to understand the origin of the tendonitis and determine its stage. If left untreated, there is a risk of chronic tendonitis and irreversible damage to the tendon. Another possible complication is calcification (calcium salt deposits), which leads to loss of mobility, stiffness, and even locking of the joint. For example, tendonitis of the wrist can develop into carpal tunnel syndrome.

How can tendonitis be prevented?

There are a number of preventive measures that can be taken to avoid tendonitis. These mainly involve exercise. Warming up before exercise is therefore essential. Exercise should be gradual, lasting at least 10 minutes, and should include stretching and relaxation of the muscles and tendons involved. It is important to perform movements specific to the sport being exercised. If you feel the need, do not hesitate to attend classes to learn the correct movements and ask a professional for advice on the right equipment. Don’t forget to stretch well after the exercise.

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Make sure you drink enough water, whether during training, recovery, or exercise. Dehydration and the resulting loss of minerals contribute to pain in the tendons, ligaments, and muscles. If your job or leisure activities involve repetitive movements, take regular breaks to relax your tendons.

What treatment is needed to cure tendonitis?

To treat tendonitis and avoid complications, it is advisable to consult a doctor as soon as the first symptoms appear. Once the diagnosis is confirmed, the doctor will usually refer you to a physiotherapist. In most cases, the treatment of tendonitis combines physiotherapy and painkillers.

Adapting exercise

During the acute phase of tendonitis, it is advisable to reduce effort or even stop the activity if the pain is very severe. Contrary to what one might think, prolonged rest is not recommended as it has little effect on the healing of the damaged tendon. It is therefore ideal to reduce the intensity of the effort in order to promote the resorption of the inflammation and the regeneration of the potentially damaged fibers. It is then important to wait for complete healing, which can be verified by ultrasound or MRI, before resuming further activity. Indeed, early resumption of sport may contribute to relapse and recurrent tendonitis.

Medicines for tendonitis

For short periods Acetominophen is the preferred treatment for the symptoms of tendonitis, especially for the pain. It has no effect on inflammation or tendon healing. NSAIDs such as Ibuprofen can also be used either orally, as an ointment, or as a  patch applied to the affected area of the tendonitis. The use of these medicines is subject to medical advice and should not last longer than 1 week. Warning: some NSAIDs, particularly diclofenac, are associated with a risk of photo-sensitization and should therefore be avoided in the sun.

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Thermotherapy and massage

Thermotherapy, more specifically cryotherapy, is a non-medicated method that can be used in the acute phase of tendonitis. This cold therapy can be performed with an ice pack placed in the freezer or an instant cold pack. Cold causes vasoconstriction, has an anti-inflammatory effect and reduces edema. To avoid cold burns, it is recommended to place a cloth between the skin and the equipment used. It can be used for 20 minutes.

To relieve tendon pain, it may be useful to alternate massages with thermotherapy. You can use a special massage cream or balm containing active ingredients such as arnica, silica, wintergreen, camphor, or menthol.

Orthotics: Braces for tendonitis

In the case of tendonitis, it is often advisable to wear braces adapted to the affected area of the body. This is because braces restrict the movements that cause tendonitis thus and helping regenerate the damaged collagen fibers. Orthotics allow you to continue your normal activities while reducing the pain caused by tendonitis. They are also recommended when returning to sport after tendon healing, as well as preventively. An alternative to braces is bandaging, which allows you to immobilize the affected tendon using an elastic adhesive bandage.

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Functional rehabilitation

Functional rehabilitation by a physiotherapist can start as soon as the acute phase of tendonitis is over. Depending on the severity of the tendonitis, this rehabilitation can last from 3 to 6 months. It is based on gentle stretching, strengthening, ultrasound sessions, and massage. Functional rehabilitation aims to stimulate the formation of new collagen fibers, which will strengthen the tendons.

Injections and surgery

If tendinitis does not respond to the above treatments, corticoid injections may be considered. Another method is to inject PRP (platelet-rich plasma), which is plasma rich in platelets and obtained by centrifuging a sample of the patient’s blood. The injections are given directly into the affected tendon to provide growth factors. Depending on the case, 2 to 3 injections are needed. They are given 3 to 6 weeks apart and under medical supervision. In the most serious cases, such as tendon rupture, surgery is required to repair the damage.

Final thoughts

Tendinitis is an inflammation of a tendon. It is common in athletes, but also in people who perform repetitive movements due to their profession or hobby. The main symptom of tendonitis is pain, which may be associated with swelling in the affected area, a feeling of heat, or contractions. To prevent tendonitis, it is important to warm up the tendons before sports and activities involving them. It is also important to choose the right equipment and to perform technical movements correctly. To treat tendonitis, it is interesting to combine a tailored activity and pain medication with various therapeutic methods such as thermotherapy, massage, and orthotics. Functional rehabilitation with a physiotherapist is important, especially for athletes. Injections and surgery are reserved for the most severe cases, especially those involving ruptures.

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