The tendon is at either end of a muscle and is the part that attaches the muscle to the bone. Tendonitis is a commonly used term that many of our patients have heard of, and it usually occurs when the tendon is placed under a tensile force that is too heavy or sudden for it to be able to cope with.
The term tendinitis although commonly used, has now been replaced with tendinosis or tendinopathy. This is because it was once thought that the symptoms were caused by micro-tears occur within the tendon resulting in inflammation. However, recent research shows that in most cases there is a lack of inflammation around the tendon, and the symptoms are being caused by degeneration is the tendons collagen instead.
As patients who have had tendinosis, it most commonly affects the areas where we place the most repetitive strain on our tendons, such as the foot, wrist, shoulder, elbow, knee and the heel.
As we’ll explore in this article, there are diverse reasons why tendinosis develops, and while it is possible to cure your tendinosis completely, there is no one-size-fits-all treatment. In all cases, early detection is key to enabling effective treatment interventions sooner rather than later, which increases your likelihood of positive outcomes. Read on to find out how to relieve your tendonitis symptoms, speed up your recovery and prevent recurrences.
Understanding Tendonitis / Tendinosis
Because tendinosis is a general umbrella term used to describe a range of tendon issues and injuries, it doesn’t always look the same in every person. The most common symptoms are pain in or around the tendon, mild swelling which may be accompanied by skin discolouration, reduced mobility, stiffness and/or weakness at the site. You may also hear or feel a cracking or popping sensation when you move the joint around.
People develop tendinosis for many different reasons. The most common cause is repetitive strain injury, where repeated movements or postures place excessive strain the tendons. Tendinosis can also be caused by a sudden impact or injury, usually during sport – for example, from lifting a heavy weight without proper warm-up.
While tendinosis is a very common condition that anyone can develop, some population groups are more at risk of tendonitis. These include older people, people who are obese and people whose work or hobbies involve awkward postures and/or repetitive movements. Medical conditions, like diabetes and some medications, can also increase your risk of developing tendonitis.
Situational risk factors like poor posture, poorly designed routines, and/or unsuitable equipment while working or exercising can also increase your risk of tendinosis. Later in this post, we’ll discuss preventative measures you can take to protect yourself
How Does Age Affect the Development of Tendonitis / Tendinosis?
People of all ages can develop tendinosis, but it is more common in people over 35. This is because tendon flexibility often decreases with age, putting older people at greater risk of tendon-related strain and injury.
Diagnosing Tendonitis / Tendinosis
If you suspect you have tendinosis, it’s important to seek a diagnosis from a healthcare provider, as many symptoms of tendinosis are the same as other medical conditions that may require a different course of treatment. Usually, tendinosis is diagnosed through a physical examination.
Early intervention is key to treating tendinosis successfully, so you should make a visit to your doctor, physiotherapist or osteopath as soon as your symptoms arise.
Treatment Options
When treating tendinosis, seeking advice from a medical professional can help you get an accurate diagnosis of your symptoms and a tailored treatment plan to help you rehab your symptoms. The idea of any rehab plan for tendinopathy is to go from pain to performance without pain which can take up to 3 months.
Also getting an understanding of why your symptoms have occurred is important, if possible, as this can help you try and prevent your symptoms from reoccurring in the future.
While you should always seek a medical opinion to determine the best course of treatment for your personal case, we’ve outlined some options below to help you get started.
Home Remedies and Self-Care
The advice around tendinopathies has changed over recent years and might be different to what you think you should do.
Previously the advice would be to follow the R.I.C.E protocol, which would be to Rest, Ice, Compress and Elevate the injured area. Whilst some of this advice is still appropriate, the new protocol to follow is called PEACE & LOVE.
This stands for: Protect, Elevate, Avoid Anti-inflammatory modalities, Compress, Educate & this advice should be followed immediately after the injury has occurred. When your symptoms are starting to improve, the move onto the second bit of advice: Load, Optimism, Vascularisation, Exercise.
Initially, you want the pain and swelling to reduce as quickly as you can, so by protecting the injured tendon from further injury & keeping it elevated (higher than your heart) is useful and easy to do at home. Avoiding anti-inflammatory modalities refers to using anti-inflammatory medication & using ice. Whilst both these modalities might help your symptoms in the short term, they may have a negative impact on long term tissue repair.
For longer term treatment, the advice now is to load tendons. Our muscles, tendons and joints are all designed to move, so it’s no wonder that they respond well to movement and exercise. This part of rehab should be done alongside a professional to help prevent re-injury from happening.
Alternative Therapies
In most cases of tendinosis, the symptoms are managed with conservative treatment & introducing the right exercises at the right time is key especially for the long term. Seeking advice and treatment from a physiotherapist or osteopath could help you navigate the healing process and get back to the work, sports or activities you need to do sooner and more safely while minimising your risk of recurrence.
Recent research confirms that the range of modalities osteopaths use may be beneficial in treating musculoskeletal disorders. Often following an injury, such as with tendinopathy, we move and function differently perhaps because of pain or apprehension that there might be pain which in time, can place extra strain on your body and affect your general fitness and progress. Consulting with an osteopath can help to minimise these unwanted side effects of rest. They can give you a strengthening and stretching routine to help you maintain your overall well-being and mobility while healing and even speed up your healing time.
While many people turn to massage for muscle relief, this isn’t always the best approach with tendinopathies. Stick to remedial massage administered by a qualified osteopath (https://brightosteopathy.org/muscle-pain-problems/) or physiotherapist with a strengthening and stretching routine.
Acupuncture is another commonly recommended alternative treatment option for tendinosis, with early research showing promising results for short-term relief. While some people recommend herbal supplements to reduce systemic inflammation, research does not prove their efficacy.
Recovery and Rehabilitation
As we’ve mentioned, initially when your tendinosis occurs, it is important to protect the area accordingly. Resting is important, but it is also important to use the surrounding muscles & joints to encourage blood flow in and around the area. You should start to notice a reduction of symptoms within a few days, this is when listening to your body is key, seeing what movements or activities aggravate your symptoms. Full recovery may take longer, up to 3 months, but is a few cases symptoms will last longer. It depends on the underlying cause of your tendinopathy and other personal factors.
Focusing on rehabilitation is a great way to speed up your recovery, improve your chances of making a complete recovery and reduce your risk of recurrence. An osteopath or a physiotherapist can work with you to design a stretching and strengthening program that will allow you to remain as active as possible while staying safe during your recovery. This will speed up your healing time and help prevent reinjury in the future. Rehabilitation is particularly important for athletes looking to return to their pre-injury level of performance. It’s also an important element of proactive pain management.
Recurrence is very common in tendinosis because these symptoms can be caused by repetitive movements, so unless the underlying cause is addressed, reinjury can occur. In that case, you place yourself at increased risk of recurrence and eventually, this can lead to chronic tendonitis, which becomes harder to treat. Working with an osteopath will help you make appropriate modifications to your movements, posture, and lifestyle to minimise your risk of developing a chronic issue – more on that below.
In cases where an underlying medical condition or medication is causing tendinosis, your rehabilitation timeline may look different and may be more like symptom management. You should work closely with your medical practitioner to determine the best course of treatment.
How Long Does It Take for Tendonitis / Tendinosis to Heal?
The length of healing time for tendinosis varies depending on the severity, cause, area of the body affected and a range of other individual factors. With appropriate symptom management, you should start to feel relief within a few days, but full recovery may take a few months.
Can Tendonitis / Tendinosis Go Away on Its Own?
Tendinosis often goes away with minimal intervention, but that doesn’t mean you can ignore your symptoms. Often, cessation of the activity that caused the tendinopathy in the short term is enough to allow your symptoms to settle, sometimes within as little as a few days. However, recurrence and chronic tendonitis / tendinopathy are also common. You should seek medical advice for a personalised treatment plan to prevent it from becoming a chronic injury.
Can Tendonitis / Tendinosis Lead to More Serious Injuries?
While most people recover from tendinosis with conservative treatment, unaddressed tendinosis can eventually lead to more severe tendon degradation, which increases the risk of rupture or tear. Treatment and recovery from this more severe injury are much more involved, and surgery may be required.
Lifestyle Modifications and Prevention
As discussed, tendinosis is most commonly caused by RSI. Poor posture and workflow design can increase your likelihood of developing tendinosis, and when triggers are not addressed, you may be at risk of developing a chronic, recurring condition. If a workday activity brought on your tendinosis, try our tips for improving posture at work.
Exercise injuries are another common cause of tendinosis. Not warming up adequately, going too hard too soon with weights, and running on hard surfaces are common culprits. There’s nothing worse than having to put your training on hold to recover from an injury. If you’re starting a new exercise regime or finding that you’re dealing with frequent pain after exercising, consider consulting with an osteopath or physiotherapist to get tailored advice on how you can prevent future strains.
An osteopath can also help to support tendon health with a tailored strengthening regime. If you’re struggling with recurring tendonitis / tendinopathy or are at increased risk of tendonitis due to your age or a medical condition, you may benefit from ongoing specialist support to reduce pain and increase overall strength and mobility.
Finally, obesity places increased strain on the tendons, increasing the risk of tendinosis. Where safe and appropriate, losing excess body weight can help prevent future tendon-related injuries.
Tendinosis is a common condition that many of us deal with in our lifetimes – especially as we age. The good news is that most cases resolve with rest and minimal intervention. There are many non-invasive treatment options if you are dealing with chronic tendonitis. Working with an osteopath can lead you to a strong recovery and minimise your risk of recurrence with simple preventative measures and lifestyle adjustments that will keep your tendons healthy and functional.