Tendinopathy

A tendon is a strong cord that joins muscle to bone. Tendinopathy is tendon pain from overload: the main cause is the tendon being loaded more than it can handle.

It is mostly a failed healing problem, not true inflammation. That is why “tendinopathy” is now preferred over “tendinitis”.

The three stages

• Reactive stage — a sudden increase in activity makes the tendon swell. Early and reversible.
• Disrepair stage — repeated overload; healing fails and fibres become disorganised.
• Degenerative stage — long-standing; the tendon is weak and at risk of tearing.

Common tendinopathies and who gets them

• Achilles tendinopathy — runners
• Patellar tendinopathy (jumper’s knee) — basketball, volleyball
• Tennis elbow — racquet sports, computer and manual work
• Golfer’s elbow — golf, throwing sports
• Rotator cuff tendinopathy — swimmers, overhead workers
• De Quervain’s tenosynovitis — new mothers, heavy phone users

Symptoms and signs

• Pain at the tendon, worse with activity
• Pain eases after warming up, then returns after exercise or the next morning
• Morning stiffness
• Tenderness and thickening of the tendon
• Pain when the muscle works against resistance

Management plan

• Reduce the load, but do not rest completely. Complete rest slows tendon recovery.
• Progressive loading exercises: hold exercises (isometrics) first, then slow heavy strengthening, then jumping and sport-specific drills.
• Correct training errors, footwear and technique.
• Short-term painkillers when needed.
• Avoid repeated steroid injections — they weaken the tendon.
• Shockwave therapy or PRP for stubborn cases.
• Expect 3 to 6 months of consistent rehabilitation.