Written by Leann Poston, M.D.

Tendinitis is an often preventable and painful injury.  It is the way your body says, “You have overdone it.” Poor body mechanics, overuse injuries, or even a single forceful movement can damage or even tear a tendon or ligament. Tendinitis results from an injury in which the load repeatedly placed on the tendon exceed its capacity to handle the load—overuse results in tissue breakdown. Treating tendinitis starts with PRICE and then therapies to regain function. Healing tendons can be frustrating because the movements that resulted in tendinitis are probably the same movements you are most eager to recover.

Tendons are like stiff rubber bands that bind muscles to bones. Ligaments connect bones to bones. Tendons contain collagen fibers, water, and ground substances. The ground substance allows a tendon to stretch and then return to its original shape. This ability to stretch helps prevent torn tendons and ligaments. Many tendons are wrapped in a sheath called a synovial sheath. This sheath provides blood supply and decreases friction around the tendon.

Blood Supply

Tissues such as tendons and ligaments sacrifice blood supply to maximize tensile strength. If blood vessels run through a tendon, they would interrupt the bands of fibrous tissue forming tendons and ligaments, which would decrease the tendon’s strength, much like windows in a building decrease its ability to withstand tornado-like forces. A lack of blood supply inhibits the ability of tendons and ligaments to heal quickly after an injury.

What Is Tendinitis?

Tendinitis results when a tendon becomes swollen and inflamed after an injury. The symptoms of tendinitis include the following:

• Pain in the tendon that is worse with movement
• Difficulty moving the tendon
• Feeling a grating or crackling sensation when you move a tendon
• Swelling, sometimes with heat or redness
• A lump along the tendon

Type Of Tendinitis

Tendinitis can affect tendons all over the body, but the structural damage and methods of treating tendinitis are the same.

• Knees: Patellar tendinitis or jumper’s knees
  • Patellar tendons are under the greatest stress when jumping
  • Pain is below the knee and over the patellar tendon
• Elbow: tennis elbow or golfer’s elbow
  • Tender over the outside of the elbow (tennis elbow)
  • Tender over the inside of the elbow (golfer’s elbow)
  • Painful to grasp objects or twist the elbow
• Shoulder: Calcific tendinitis or supraspinatus tendinitis
  • Pain worse at night
  • Restricted shoulder movement, especially when moving the shoulder away from the body (supraspinatus tendinitis)
  • AC tendinitis is at the top of the shoulder and usually has a point of maximal tenderness
• Wrist and thumbs: De Quervain’s disease
  • Pain at the wrist on the thumb side
  • Pain increases when the thumb is moved across the palm towards the little finger
• Heels: Achilles tendinitis
  • Pain over the back of the ankle
  • Painful to pull the foot towards the shin
• Upper arm: Biceps tendinitis
  • Pain in the front of the shoulder
  • May hear or feel a painful popping or clicking in the shoulder
  • Reaching, overhead activities, and push/pull movements aggravate the pain
• Upper leg: Hamstring tendinitis
  • Pain in the lateral (outside) aspect of the back of the knee
  • Painful to flex the knee at a 90-degree angle

Treating Tendinitis

Steps for treating tendinitis include the following:

Step 1: Identify the cause.

If you do not know what caused the injury, it will be a challenge to prevent it from reoccurring. Without knowing the cause, the offending exercise may be continued, which will interfere with tendon healing processes.

Step 2: Decrease pain and swelling

• Immobilize the joint for protection and compression
• Rest the joint but exercise the rest of the body
• Take nonsteroidal anti-inflammatory drugs if needed
• Use cold, heat or ultrasound applications
• Elevate the injured extremity
• Consider acupuncture and electrical stimulation

Step 3: Restore the range of movement

• Start early to prevent contracture formation and atrophy of muscles
• Range of motions should be pain free and gradually progressed as tolerated
• Start flexibility exercises to lengthen the tendon gradually

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Step 4: Strength training

• Start after pain and inflammation are under control
• Start with isometric exercises
• Light intensity exercises gradually strengthen muscles attached to the tendon. Focus on eccentric or lengthening contractions.
• Slowly move to more endurance exercises

Step 5: Neuromuscular control and balance

• Exercises to restore the normal timing of muscle recruitment and restore coordination.

Step 6: Functional or sports specific training

• When strength and flexibility have been regained, start functional sports training
• Tasks are broken down into specific components and then put together as each one is mastered.

Other Options For Treating Tendinitis

• Injections of lidocaine or corticosteroids
• Needle aspiration to remove fluid
• Physical therapy to preserve motion and prevent frozen joints
• Lifestyle changes to prevent overuse injuries and speed-up tendon healing

When Do You Need Surgery?

According to SportsMD.com, a torn ligament or tendon such as an Achilles tendon tear requires surgical repair and replacement with at least 6-9 months of rehabilitation before you can return to competitive play.

Weekend warriors and other deconditioned athletes are at the greatest risk for a torn ligament or tendon. Preexisting tendon injuries, tendonitis, or previous steroid injections also increase risk. Tendon tears or ruptures are most likely to occur in areas of the tendon or ligament which have the lowest blood supply.

A torn ligament has many similarities to a torn tendon in both mechanisms of injury and treatment options. Both types of injuries start with PRICE to decrease inflammation, and both types of injuries have both medical and surgical options.

Conclusion On Treating Tendinitis

Imagine you are doing all the right things for treating your tendinitis, you have maximized the benefits of PRICE. You are fully invested in your exercise rehabilitation plan, but your tendon or ligament injury is just not healing fast enough for you.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider.  You should always consult a practicing professional who can diagnose your specific case.  The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 

References

James Wyss, M. M., & Amrish Patel, M. P. (2013). Therapeutic Programs for Musculoskeletal Disorders. Demos Medical. https://zu.edu.jo/UploadFile/Library/E_Books/Files/LibraryFile_171033_57.pdf

Micheli, L. J. (2010). Encyclopedia of Sports Medicine. SAGE Publications, Inc. https://us.sagepub.com/en-us/nam/encyclopedia-of-sports-medicine/book230719

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