Due to the nature of injury and type of pain caused by tendon damage, physical therapists play a vital role in the rehabilitation and recovery process after tendon injuries. These injuries are common and one of the most frequently seen diagnoses in our physical therapy clinics in Columbus, Ohio.

If an acute tendon injury, also known as tendonitis (or tendinitis), is mistreated, then it can lead to chronic problems and cause physical changes within the tendon itself. Avoid this process by reading this complete guide to understand more about tendinitis, how it is diagnosed, and ideas for self-treatment to improve your chances of recovery from tendon damage.

What is a Tendon and How Does it Work?

A tendon is a fibrous band of connective tissue that attaches muscles to bones and transmits forces between the two structures. Movement is produced when a muscle contracts and transmits a force through the tendon to the bone.

Tendons are made of two different components: collagen and tenocytes. Collagen fibers are known for their elasticity and incredibly strong properties. Tenocytes respond to different types of mechanical loads and help the tendon to respond to forces placed upon it. These components operate on a cellular level and are undetected by conscious thought.

Did You Know: Tendons and bone respond to force in the same manner. In bones, strength is formed through weight-loading and weight-bearing. Therefore, the amount of force that is, or is not, placed on bones will directly affect their structure. This is known as Wolff’s Law.

What is Tendinitis?

Tendinitis is defined as acute inflammation of a tendon due to excessive use or loading of the muscle. Consequently, this constant pressure and tension on the tendon can ultimately lead to the development of microtears on a cellular level.

Damage to tendons can progress from the inflammatory phase (tendinitis) to tendinosis based upon the level of microtears and irritation within the tendon. If left untreated, then tendinosis can evolve into tendinopathy.

Fortunately, tendinitis does not show any significant structural changes on an ultrasound or MRI. However, there may be a slight increase in signal intensity that can be viewed on the MRI to indicate the location of the tendinitis.

Some areas in the body are more susceptible to tendinitis than others, depending on the activity and/or sport-specific demands placed on the body. According to Dr. Junak, the location of tendinitis may be closely related to seasonal activities, especially in the Crossfit population. For example, Dr. Junak reports a higher incidence of Achilles tendinitis in the spring and summer, as opposed to winter and fall, possibly due to the increased participation in running programs during nicer weather.

Any tendon can develop tendinitis, but you are more likely to develop it in these areas:

Shoulder – If you constantly use your arms for movement, then you are predisposed to injury in any one of the four rotator cuff tendons. This includes athletes or individuals with upper body demands in their occupation, such as painters or postal service employees.
Elbow – Tennis and golfer’s elbow are common terms used to describe tendon injuries that affect the elbow joint.
Hip – Injury to the gluteal and adductor tendons are typically seen in athletes who need to perform multi-joint movements like in hockey or gymnastics.
Knee – Soccer players and runners are more susceptible to patellar, hamstring, and quadricep tendon injuries.
Ankle – Anyone who performs box jumps, sprints, or participates in a running program with progressive mileage may be at risk for Achilles tendon injury or problems with the plantar fascia.

Ask the expert:
Can tendon injuries occur in the spine? Tendon injuries in the spine are not common. This could be due to the fact that the intervertebral discs within our spinal column act as shock absorbers and help to transmit forces to the extremities where tendon injuries are more commonly seen.

The Most Common Tendinitis Injuries

Rotator Cuff Tendonitis – Rotator cuff tendonitis is one of the most common forms of tendonitis. This injury usually involves the tendon that bonds the supraspinatus muscle and the upper part of the arm bone. The cause of tendonitis in the rotator cuff almost always stems from overuse. Those of are most at risk of this injury are tennis players, swimmers, and baseball players,
Plantar Fasciitis – Plantar fasciitis refers to the inflammation of the band of tissue located at the bottom of the foot. This band is known as the plantar fascia and connects your heel bone to your toes. This form of tendonitis usually affects runners but can also occur in those who are overweight or wear inadequate shoes.
Achilles Tendonitis – As stated in the name, this form tendonitis affects the Achilles tendon. The Achilles is a thick, rope-like tendon that connects the heel bone (calcaneus) to the calf muscle. Tendonitis in the Achilles usually stems from overuse (i.e., excessive walking, running, jumping), poor running technique, and from wearing shoes that don’t fit well.
Lateral Epicondylitis – Lateral epicondylitis (tennis elbow) is a form of tendonitis that affects the outer portion of the elbow joint. It is usually caused by repeated twists and flexes of the wrist and tends to affect athletes who play racquet sports.
Medial Epicondylitis – Medial epicondylitis (golfer’s elbow) is a form of tendonitis that affects the inner portion of the elbow. While athletes who engage in sports, such as golf and baseball are likely to develop this affliction, people who work in occupational fields, such as construction, or any other job that requires repeated elbow movement, are more prone to this type of tendinitis.
Patellar Tendonitis – Patellar tendonitis (jumper’s knee) is a form of tendonitis that affects kneecap (patella). Specifically, it refers to inflammation in the tendon that connects your kneecap to your shinbone (tibia). While anyone could develop patellar tendonitis, it most frequently affects athletes who play sports, such as basketball or volleyball.

Who is at Risk for Developing Tendinitis?

Because any tendon can be affected, everyone is at risk for developing tendinitis.

Remember, tendinitis can result from repetitive movement, excessive stress on a tendon, or performing a simple action incorrectly, like picking up a milk jug at an awkward angle. It can also occur as a result from a sudden movement that the body is not accustomed to performing. It’s easiest to think of tendon injuries as either being caused by sudden injury or overuse:

Sudden Injury – When an individual engages in an activity (i.e., weightlifting), weight and the movement of the body are increased too quickly. Injuries such as microscopic tears in the tendon can occur and the inflammatory process can begin.
Overuse – Tendinitis caused by overuse, usually affects athletes and those who engage in tasks that require repetitive body motions.

Those who play certain sports, like tennis, golf, swimming, are at an increased risk for developing tendinitis due to repetitive overuse. You also may be at a higher risk if your occupation requires overhead movement or repeated movements.

Some prescription medications can predispose an individual to tendon injury due to the characteristics of the drug. Fluoroquinolones, which are prescription antibiotics, have been linked to tendinosis in research studies. Although rare, this connection highlights the importance of sharing your medical history and medication list with your healthcare professionals and rehabilitation specialist.

Signs and Symptoms of a Tendon Injury

Injuries that affect tendons tend to cause pain around the affected joint or area. Unlike trigger points, tendon pain does not travel to other regions in the body.

Other key characteristics of tendon pain include a burning, aching, or sharp sensation. Pain from tendon injuries also commonly results from movement of the injured area, stretching, or when someone touches it.

In the beginning stages of a tendon injury, pain can be constant. Other times, it can be unnoticeable except when the muscle is being used. Such a wide variation of pain intensity can sometimes make it difficult for rehab specialists to pinpoint the exact cause of pain.

Tendinitis Versus Tendinosis: Which Do You Have?

It is crucial to understand the difference between tendinitis and tendinosis for several reasons. Each diagnosis has a different treatment approach, rehabilitation goals, and expected recovery time frame. Misdiagnosis can lead to improper treatment, unnecessary medications, and long periods of rest that make the injury persist longer than usual.

In tendinitis, the priority and goal of treatment is to reduce inflammation and stress placed on the tendon. Recovery time ranges from a few days to weeks, depending on whether treatment begins with an early or chronic presentation. Tendinitis can often resolve on its own.

Treatment for tendinosis recognized at an early stage can last six to 10 weeks but can extend to six months if the tendinosis becomes chronic. In some cases, recovery can last up to nine months, especially if the tendon has calcified.

Such drastic differences in recovery periods emphasizes the importance of a correct diagnosis and timing of interventions.

Tendinitis Diagnosis and Treatment Options

Experts recommend conservative treatment for tendinitis. This includes rest, ice, and avoidance of excessive force on the injured area. Gentle isometrics, which are exercises that create tension within a muscle without active range of motion, may also be prescribed by your physical therapist to treat tendinitis.

However, many patients are often misdiagnosed with tendinitis. It’s common for tendinitis to advance to tendinosis or tendinopathy by the time patients seek care for the problem. After evaluating which tendon problem you are suffering from, Dr. Junak will recommend modifying activities that cause aggravation to the injured area and treating the injury according to the stage of the tendon problem below:

Tendonitis

This occurs 0-7 days following the initial injury.
As stated above tendonitis refers to inflammation, irritation, and small tearing of a tendon. With regard to inflammation, symptoms would present in the form of redness, swelling, joint pain and stiffness.
Treatments for inflammation include rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs).

Tendinosis

This occurs 7-30 following the initial injury.
Tendinosis is referred to as the deterioration of a tendon’s collagen and is a response to the continued overuse of a damaged tendon.
Treatments for tendinosis include tendon loading protocol, dry needling, and cupping therapy.

Tendinopathy

This is a chronic tendon problem.
Tendinopathy is referred to as chronic tendinitis that includes swelling, pain, impaired function, due to a damaged or possibly torn tendon. Depending on the degree of tendinopathy, a tendon could possibly be treated without surgery.
Treatment for tendinopathy includes modification of activities or work, corrective exercises, tendon protocol, dry needling, and cupping therapy.

Who Requires Surgery After a Tendon Injury?

Almost 90% of individuals with tendinitis completely recover using conservative treatment. Risk for surgical intervention for people with tendinitis is extremely low.

Those with degeneration in their tendons and/or tendinopathy are at a high risk for tendon tears. Surgery may be required for those who suffer complete tears in the tendon. Although uncommon, individuals with incomplete tendon tears who do not heal with physical therapy may also require surgical intervention.

Get Tendinitis Pain Relief at our Physical Therapy Clinics in Columbus, Ohio

Tendon injuries can be painful, frustrating, and counterproductive to your daily activities. Tendon pain can get in the way of simple tasks, job duties, and workout programs. Figuring out how to manage your recovery process can help prevent the injury from worsening, and that includes learning how to modify your activity level.

If you have suffered with tendon pain for a while, then it is likely that you are suffering from tendinosis, not tendinitis. Tendinosis is commonly misdiagnosed in the medical community and refers to structural changes within the tendon that do not necessarily respond well to anti-inflammatory treatments. The best treatment approach for those who suffer with tendinosis is physical therapy and modification of activity.

For those experiencing varying degrees of tendinitis and would like to understand your options with regard to treatment, Contact Peak Physiotherapy and Performance for a Free Phone Consultation today. We have physical therapy clinics in Columbus, Canal Winchester and Blacklick, Ohio. We also have Telehealth options for other located outside of the Columbus area.

To learn more about sports injuries and how Peak Physiotherapy and Performance solves tendon pain, download our FREE Ebook: The Ultimate Guide To Recovering From The 7 Most Common Sports Injuries, by clicking the link.

About the Author

Dr. Andrew Junak is a Doctor of Physical Therapy and Board-Certified Orthopedic Specialist. Dr. Junak received his Doctorate of Physical Therapy from Walsh University and completed his Orthopedic Specialist training at the Cleveland Clinic. He is the owner of Peak Physiotherapy and Performance, a physical therapy clinic in Canal Winchester, Ohio. He serves the local communities of Lancaster, Grove City, Pickerington, and Columbus. Dr. Junak is passionate about helping people solve their problems in order to get them back to doing the things they love.

What is Tendonitis? Understanding Tendon Pain and Treatment Options