Tendonitis: Symptoms and treatments

If you have a tendon that has become inflamed, the condition is known as tendonitis. In many cases this inflammation is the result of an injury or overusing a tendon. But what are tendons exactly?
 
Connecting your muscles to your bones, tendons are strong, rope-like structures made from flexible tissue that are found all over your body. When your muscles contract and expand, your tendons work as levers to move your bones.
 
Tendons also protect your muscles by absorbing some of the stress impact movements such as running and jumping put on them. But while they are made from flexible tissue, tendons aren’t very stretchy – unfortunately this means they’re prone to injury. And when they become injured, they can often take a long time to heal.
 
Tendons are made up mostly of collagen and elastin plus a few other components:
 

• Endotenon – this is the connective tissue that surrounds the bundles of collagen fibres

• Epitenon – a thin layer of tissue that surrounds the tendon

• Paratenon – found outside the epitenon this is a loose layer of tissue

• Sharpey fibres – these attach tendons to bones

• Synovial sheath – some tendons, such as those in the wrists and hands, are surrounded by this protective layer of tissue

 
Meanwhile, the musculotendinous junction is the point where a tendon attaches to a muscle, while the osteotendinous junction is where a tendon attaches to a bone.
 

Tendonitis or tendinosis?

 
Besides tendonitis there are a few other medical terms for tendon problems:
 
Tendinosis is the term used when a tendon is damaged but – unlike with tendonitis – there is no inflammation. The usual cause of tendinosis is degeneration of a tendon, often caused by small tears in the tendon. People with tendonitis can sometimes develop tendinosis.
 
Tenosynovitis describes inflammation of the synovial sheath.
 
Tendinopathy isn’t a single condition, rather it’s a general term for any type of tendon problem.
 
To further confuse matters, you may also come across the term tendinitis. However tendinitis and tendonitis are exactly the same condition.
 

Which tendons are affected in tendonitis?

 
We have thousands of tendons from our heads to our toes. Any tendon can become inflamed, causing tendonitis. But some are more prone to inflammation than others simply because we use them more, including those in the ankles, shoulders, elbows, knees, wrists and fingers. Different types of tendonitis affect specific tendons, including:
 
Achilles tendonitis   This affects the tendon at the back of your ankle that attaches your heel to your calf muscle, the Achilles tendon. This tendon is the strongest and largest tendon in the body, and it absorbs a lot of stress impact when you jump, run and walk. Because of this, Achilles tendonitis is a common sports injury.
 
Supraspinatus tendonitis   The supraspinatus tendon is attached to the supraspinatus muscle, which is the smallest of the four muscles that make up the rotator cuff of the shoulder joint. Supraspinatus tendonitis is often called swimmer’s shoulder, as experts think it’s a major cause of shoulder pain in swimmers who train intensively. When other tendons in the rotator cuff are also injured, the condition is called rotator cuff tendonitis, rotator cuff syndrome or biceps tendonitis.
 
Lateral epicondylitis   Also called tennis elbow as it often affects tennis players, this is tendonitis of the elbow. With lateral epicondylitis, pain is felt on the outer side of the elbow joint.
 
Medial epicondylitis   Like lateral epicondylitis this is also tendonitis of the elbow, but this time it causes pain on the inner side of the elbow. It’s often called golfer’s elbow, but any repeated elbow movements can cause it – people who do construction work, for instance, can be susceptible to developing medial epicondylitis.
 
Patellar tendonitis   Also called jumper’s knee, this is tendonitis of the knee. Inflammation of one of two tendons can cause patellar tendonitis, namely the patellar tendon in the lower part of the kneecap and the quadriceps tendon in the upper part of the kneecap.
 
Wrist tendonitis   Strictly speaking this isn’t tendonitis but tenosynovitis. Also called de Quervain’s stenosing tenosynovitis it develops when the synovial sheath around the tendons between the thumb and wrist become inflamed.
 
Trigger finger   Again a type of tenosynovitis rather than tendonitis, this most often affects the ring finger, little finger or thumb. Also known as stenosing flexor tenosynovitis, it causes a finger to become locked after it has been bent. If the finger is then pulled straight, it can make a clicking or popping sound. We don’t know exactly what causes it, but it’s thought to be the result of inflammation of a synovial sheath.
 
Anybody of any age can get tendonitis, but it’s thought to be most common in middle-aged people, particularly those who play a lot of sport. Exactly how many people are affected isn’t clear, as many may develop mild tendonitis and don’t seek medical treatment,
 
If you do develop tendonitis, however, it can take weeks to several months before you recover fully, depending on which tendon is affected and whether or not it’s practical for you to rest the affected part of your body (right-handed people with tendonitis in their left wrist may, for instance, recover more quickly than those with tendonitis in their right wrist – and vice versa). 
 

What are the symptoms of tendonitis?

 
The main symptoms of tendonitis include the following:
 

• Pain that becomes worse when you move the affected area

• Swelling and tightness

• Tenderness

• Stiffness and weakness

• Difficulties with movement

• A lump in the tendon

• Skin that feels warm and/or looks red or darker than your normal skin colour

• A grating, crackling or popping sensation when you move (this is called crepitus)

 
The pain of tendonitis often starts gradually and tends to be more like a dull ache than a sharp sensation – though it can sometimes start suddenly and feel sharp. It can be difficult to tell the difference between the pain of tendonitis and that of a muscle strain – though you should be able to pinpoint where the pain is happening, and if it happens where a muscle attaches to a bone it’s more likely to be tendonitis.
 

What causes tendonitis?

 
A sudden injury can cause tendonitis, but lots of repeated minor injuries can trigger it too, such as when you overuse a tendon (this is also called a repetitive strain injury). Some of the repetitive movements or activities that can lead to tendon overuse include writing, typing, assembly line work, running, cycling, dancing, gardening, painting, shovelling and working with your hands for long periods, not to mention many sports such as golf, tennis, skiing and even some workouts where you repeat the same movements over and over. It’s also thought that not stretching properly after working out or even poor posture could make you more vulnerable to developing tendonitis.
 
Some medical conditions are thought to be linked with tendonitis too, including diabetes, rheumatoid arthritis, osteoarthritis, gout, thyroid disorders and – very rarely – infections where bacteria enter a wound and infect a tendon. In some cases, however, tendonitis can seem to happen for no obvious reason.
 
Besides the above, other risk factors for tendonitis include your age, because as you get older your tendons become less flexible and can tear more easily. Some medicines are also thought to increase your risk for tendonitis, including antibiotics called fluoroquinolines, some steroid medicines and drugs used to lower the risk of breast cancer called aromatase inhibitors.
 
According to the American Academy of Orthopaedic Surgeons, smoking may also increase your risk of developing tendonitis, as smokers have been found to be 1.5 times more likely to experience overuse injuries than non-smokers (i). A review of studies, meanwhile, suggests obesity could be another risk factor, since carrying a lot of extra weight may put additional strain on your tendons (ii).
 

How is tendonitis treated?

 
The NHS says that if you treat mild tendonitis yourself at home you should feel better within two or three weeks (iii). Here’s what you should do:
 

• Rest and try to avoid moving the affected part of your body for two or three days

• Place an ice pack on the injury for up to 20 minutes every two or three hours – if the ice pack doesn’t have a cover, wrap it in a tea towel before putting it next to your skin (you could use a bag of frozen peas if you don’t have an ice pack, again wrapping it in a tea towel or similar)

• Use a support bandage or tube bandage to cover the area in question, you can buy these online or at pharmacies (make sure the bandage isn’t too tight) – however remove the bandage before you go to bed

• Start to slowly move the injured area when it feels less painful – this will help prevent the joint from becoming stiff (gentle stretches can also help improve mobility)

 
Meanwhile avoid using heat packs, having hot baths, drinking alcohol or massaging the area for the first few days, as this can help prevent further swelling. However after three days you could use heat packs or pads instead of ice packs as heat can help your muscles to relax (alternatively use a heat spray, gel or balm).
 
If you need pain relief, taking paracetamol or ibuprofen can be helpful. Alternatively you could try using a topical painkiller, such as ibuprofen gel.
 

Can natural supplements help?

 
If you want to try something more natural, however, there are a few options you can try that may help reduce pain and inflammation:
 
Bromelain   Made of proteolytic enzymes (protein-digesting enzymes) found in pineapple juice and the stem of pineapple plants, bromelain is often used as a treatment for sports injuries. One study suggests it may help reduce swelling and tenderness (iv), and experts believe it may be as effective as non-steroidal anti-inflammatory drugs (NSAIDs) as an anti-inflammatory agent (v). Researchers elsewhere have found that a daily bromelain supplement may promote healing in Achilles tendon injuries (vi).
 
High-strength fish oils   The omega-3 fatty acids found in fish oil may also be useful in reducing inflammation (vii), with researchers describing it as a useful, side-effects-free alternative to conventional anti-inflammatory painkillers (viii).

If you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3, which is sourced from plant organisms called microalgae rather than fish oils.
 
Turmeric   A member of the Zingiberacae plant family, turmeric is often recommended by natural health practitioners for conditions that cause inflammation. As well as giving colour and flavour to curry dishes, it contains an antioxidant called curcumin. There is some evidence that extracts of plants belonging to the Zingiberacae family are effective painkillers (ix).
 
PEA   Short for palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (x), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xi) with no known side effects (x).

Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (x). When this happens PEA supplements may be helpful, with 16 clinical trials and meta-analysis of PEA suggesting it does help relieve pain (xii).
 
Magnesium   This important mineral is found naturally in the body and is needed for more than 300 biochemical reactions, including muscle and nerve function. It’s also been studied in a variety of pain conditions, with researchers finding it may help with the pain of many (xiii) – though experts admit research is still at an early stage and more large-scale studies are needed to better understand how magnesium may help manage chronic pain. 
 

Further medical treatments

 
If you’ve tried self-help methods for your tendonitis but your symptoms don’t get any better and you’re in constant pain, it’s a good idea to see your GP. Your doctor may refer you for treatments or therapies such as:
 

• Steroid injections for short-term pain relief

• Physiotherapy – this usually includes learning how to do exercises that aim to make the muscles of the damaged tendon stronger

• Surgery – this can repair a ruptured tendon or remove damaged tissue in severe tendonitis, though it’s a rarely needed option

• Shock wave therapy – some specialists may recommend trying shock wave therapy when tendonitis doesn’t heal and there are calcium deposits around the tendon (the shock waves break up the calcium deposits)

• Autologous blood injection may be offered when all other treatments haven’t worked – this involves taking some of your blood and injecting it into the area around the damaged tendon

 

Can you prevent tendonitis?

 
There may not always be anything you can do to avoid tendonitis but there are a few steps you can take that may help lower your chances of developing it, including:
 

• Avoid repetitive movements whenever you can – however this may be harder than it sounds, especially if your job involves repetitive movements. If you can’t avoid repetitive movements, at least try to take regular breaks. Meanwhile talk to your employer if the work you do is causing persistent problems with tendon overuse

• Always try to warm up before exercising and cool down and stretch afterwards

• When taking up a new sport or activity, try to ease yourself into it gradually – if possible, take a few lessons with a qualified instructor before you start to learn the correct postures and techniques

• Consider varying your exercise routine so you don’t keep doing the same movements

• If you feel any pain while you’re exercising, always stop and rest

• Try to keep your muscles strong and flexible – consider adding some weight or resistance training to your exercise regime, as well as some stretching exercises

• If you’ve already had tendonitis, use a brace or strap on the affected joint when you start exercising or playing sports again, as this can help protect and support the previously damaged tendon

 

Need more information?

 
There’s lots more to discover about a range of conditions that cause pain in the pain section of our pharmacy health library.  We also have information you may find useful in our joints and mobility section, including an article on sprains and strains, and another on sports injuries.

 

References:

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5. Muhammad ZA, Ahmad T. (2017) "Therapeutic uses of pineapple-extracted bromelain in surgical care - A review." J Pak Med Assoc. 67(1):121-125. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28065968.

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8. Maroon JC, Bost W. (2006) "Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain." Surg Neurol. 65(4):326-331. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0090301905007743?via=ihub.

9. Lakhan SE, Ford CT, Tepper D. (2015) "Zingiberaceae extracts for pain: a systematic review and meta-analysis." Nutr J. 14:50. Available at: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-015-0038-8.

10. Clayton P et al. (2021) "Palmitoylethanolamide: A Natural Compound for Health Management." Int J Mol Sci. 22(10):5305. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/.

11. Clayton P et al. (2023) "Palmitoylethanolamide: A Potential Alternative to Cannabidiol." J Diet Suppl. 20(3):505-530. Available at: https://www.tandfonline.com/doi/full/10.1080/19390211.2021.2005733.

12. Gabrielsson L, Mattsson S, Fowler CJ. (2003) "Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy." Br J Clin Pharmacol. 110:359-362. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094513/.

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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