Tendonitis: Symptoms, Causes, Treatment and Recovery

01What

What is tendonitis?

A tendon is a strong, flexible band of collagen that transmits the pull of a muscle to a bone. When a tendon is repeatedly overloaded, its structure changes: it may thicken, become disorganised and develop small areas of damage, with increased sensitivity. The traditional term “tendonitis” suggests inflammation, whereas the preferred term “tendinopathy” describes the tendon’s failure to cope with load. Both are used in everyday language.

02Sites

Common sites

• Shoulder: rotator cuff and biceps tendons. See supraspinatus injury.
• Elbow: tennis elbow and golfer’s elbow. See tennis elbow.
• Wrist and hand: de Quervain’s and trigger finger. See hand and wrist tendonitis.
• Hip: gluteal tendons (greater trochanteric pain) and hamstring origin.
• Knee: patellar and quadriceps tendons. See patellar tendonitis.
• Ankle and foot: Achilles, peroneal and tibialis posterior tendons.

03Causes

Causes and risk factors

• Sudden increase in activity, training volume or intensity.
• Repetitive movements at work or sport; poor technique or equipment.
• Inadequate warm-up and recovery.
• Age over 35, when tendons lose some resilience.
• Obesity, diabetes, thyroid disease and inflammatory conditions.
• Certain medicines: fluoroquinolone antibiotics, corticosteroids and statins have been linked to tendon problems.
• Previous tendon injury, muscle weakness and biomechanical factors.

04Symptoms

Symptoms

• Localised pain at or near the tendon, worse with the loading activity.
• Stiffness after rest, such as first steps in the morning, that eases with warming up and may return afterwards.
• Tenderness and sometimes swelling or thickening of the tendon.
• Pain when contracting the muscle against resistance or stretching it.
• Gradual onset in most cases; sudden severe pain suggests a tear.

05Diagnosis

How it is diagnosed

A doctor or physical therapist can usually diagnose tendonitis from the history and examination, locating the painful tendon and reproducing symptoms with loading tests. Ultrasound or MRI can show tendon changes or tears but are not always needed, since abnormal findings are common in people without pain. Tests are used when the diagnosis is uncertain, a tear is suspected or the response to treatment is poor.

06Principles

Treatment principles

• Relative rest: reduce, not eliminate, the aggravating activity; complete rest weakens the tendon.
• Pain relief: paracetamol, topical anti-inflammatory gels and, sometimes, short courses of oral anti-inflammatories. Ice or heat for comfort.
• Progressive loading: the central treatment (see below).
• Address contributing factors: technique, equipment, ergonomics, footwear and training errors.
• Strengthen the kinetic chain: the muscles around the joint and in the rest of the limb.
• Patience: tendons heal slowly, and consistency matters more than intensity.

07Exercise

Exercise-based rehabilitation

• Phase 1 – isometrics: hold a muscle contraction against resistance for 30–45 seconds, 4–5 times, once or twice daily to ease pain and begin loading.
• Phase 2 – isotonic strengthening: slow, controlled lifting and lowering (about 3 seconds each) with moderate load, 3 sets of 8–15, three times a week.
• Phase 3 – heavy slow resistance and eccentric loading: increase load progressively as pain permits.
• Phase 4 – energy storage and sport-specific work: hopping, jumping, throwing or similar, introduced gradually.
• Pain during exercise of up to 3–4 out of 10 is acceptable if it settles within 24 hours.
• A physical therapist can adapt the programme to the tendon and the person. See also muscle strain treatment for the PEACE and LOVE approach.

08Injections

Injections and other treatments

Corticosteroid injections can give short-term pain relief in some tendons (for example shoulder, hand) but may weaken tendon tissue, particularly with repeated use around weight-bearing tendons such as the Achilles and patellar tendon. Platelet-rich plasma, shockwave therapy, ultrasound, laser and other modalities have mixed or limited evidence and are generally used as adjuncts. Surgery is rarely needed and is considered for persistent cases after months of structured rehabilitation, or for ruptures.

09Time

How long does it take to heal?

Mild tendonitis often improves in 2–6 weeks, whereas established tendinopathy may need 3–6 months of progressive loading. Early cases respond more quickly. Premature return to sport, ignoring pain or abandoning exercises explain many recurrences. Keep a maintenance programme after recovery.

10Prevention

Prevention

• Warm up and increase activity gradually, no more than about 10% a week.
• Strengthen the muscles that load the tendons.
• Vary activities and allow recovery days.
• Check technique, equipment and ergonomics.
• Wear appropriate footwear.
• Do not ignore early pain; modify activity early.
• Ask about tendon risks before using fluoroquinolone antibiotics if you have had tendon problems.

12Cases

Three common situations

A runner with Achilles pain that eases after warming up: classic tendinopathy; adjust running volume and begin heel raises.

An office worker with wrist pain after a new keyboard: review ergonomics and begin gentle strengthening.

A tennis player with outer elbow pain: check the grip, racquet and technique; start isometric exercises.

13Summary

Key points to remember

Tendonitis is an overload condition that improves with load management and progressive strengthening. Avoid prolonged rest and repeated steroid injections, address contributing factors and be patient. See a doctor for severe pain, a pop or lack of improvement. Our physical therapy team can design a programme for you.

This guide is for general information and does not replace an assessment by your own doctor or physical therapist.