What is Tendonitis?

Definition of Tendonitis

Photo of a man running up the stairs.
The Achilles' tendon is often subject to tendonitis. DaveLongMedia/ E+/ Getty Images

Tendonitis describes inflammation, swelling, and irritation of a tendon. Tendonitis is a painful condition that is felt most at the tendon insertion site - the place where the tendon attaches to your bone. You may also experience along the length of a tendon near the point where your muscle and tendon come together.

Tendons are bands of fibrous material that attach muscle to bone. There are many tendons in our body. In fact, every muscle has a tendon that attaches it to bone.

Tendons therefore can be large in size, such as the tendons around our knee joint, or small like the tendons in our fingers. Sometimes tendons attach to your bone in a fibrous band of tissue, such as occurs in the rotator cuff of your shoulder.

When these structures are irritated, they can swell and become inflamed. This is a condition called tendonitis. The suffix -itis refers to inflammation. Arthritis is inflammation of a joint, bursitis is inflammation of a bursa, and tendonitis is inflammation of a tendon. Tendonitis typically describes acute irritation of the tendon. If you have chronic tendon problems, it is often referred to as tendonosis or tendonopathy.

Learning about tendonitis and how it is treated in physical therapy can help you understand your own course of rehab when dealing with tendon problems.Take a moment to learn about tendonitis by clicking through this step-by-step slide show. 

Causes of Tendonitis

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Improper training form may cause tendon problems. John Fredele/Getty Images

Tendonitis can result from several different etiologies. Overuse of the tendon during work or recreational activities is the most common cause of tendonitis. People who work on an assembly line are often prone to developing tendonitis due to the repetitive nature of their job. Tennis and golf are two activities that commonly cause tendonitis of the elbow due to the repetitive motion at the elbow.

Direct injury—such as a blow or a fall to the tendon—can also result in tendonitis. Various inflammatory conditions, such as rheumatoid arthritis or osteoarthritis, may cause biomechanical changes that cause tendonitis.

Lastly, aging can make you more prone to developing tendonitis. As we age our tendons lose their elasticity and water content, making them more susceptible to irritation and inflammation.

Symptoms of Tendonitis

Painful shoulder conditions may need physical therapy to help return to normal.
Physical Therapy can help if you have shoulder pain. Stockbyte/Getty Images

If you are feeling pain, how do you know it is tendonitis? Typically, inflammation of any structure in the body is signified by certain hallmarks. The signs of inflammation are:

  • Increased tissue temperature
  • Pain
  • Swelling
  • Redness

If you have any of these signs or symptoms over a tendon, then tendonitis may be the cause of your pain.

Tendonitis results in:

  • Tenderness- Your PT may touch, or palpate the skin over your tendon, and this may result in pain. Painful palpation is a sign of possible tendonitis.
  • Pain- When contracting the muscle attached to the affected tendon, it may cause pain. This pain with resistance may indicate that tendonitis is a cause of your problem.
  • Stiffness- Many tendons course through your body in a fibrous sheath, and when inflammation and swelling occurs, this flossing in the sheath becomes limited. This occurs with tendonitis, so stiffness after a period of rest may occur.

Next up: Where do we commonly feel tendonitis?

Common Locations of Tendonitis

Photo of a tennis player holding a painful knee.
Knee pain from PFSS requires you to take action right away to get back in the game. Westend61/Getty Images

Tendonitis often occurs most commonly in tendons associated with increased use. More common types of tendonitis include:

  • Achilles tendonitis
  • Patellar tendonitis
  • Elbow tendonitis like tennis elbow or golfer's elbow
  • Biceps tendonitis
  • Rotator cuff tendonitis

Of course, tendonitis can occur in any tendon anywhere in the body. Your doctor and PT can help determine the exact tendon that is inflamed and prescribe the best treatment for your tendonitis.

Treatment of Tendonitis

Photo of woman getting ultrasound in physical therapy.
Ultrasound is a therapeutic modality used in PT. Is it right for you?. UpperCut Images/ Getty Images

Treatment of tendonitis involves resting the involved tendon and decreasing inflammation. Resting the involved tendon through avoidance of increased activity or even immobilizing the area is the first mode of treatment. Many people use the R.I.C.E. acronym for injury management. This stands for rest, ice, compression, and elevation.

Some PTs are advocating using the P.O.L.I.C.E. protocol after injury. Instead of rest, the P.O.L.I.C.E. protocol calls for protection and optimal loading and then ice, compression, and elevation. Some people with tendonitis rest too long, developing contractures or difficulty regaining range of motion when tendon problems strike, so the P.O.L.I.C.E. method ensures that you keep things moving after injury.

Steroid injections or non steroidal anti inflammatory medications provided by your physician can directly decrease inflammation and the pain associated with tendonitis.

Physical therapy to gently stretch and strengthen the affected tendon is vital to recovering and preventing future tendonitis episodes. Your physical therapist can assess your mobility and help determine the faulty mechanics that are overloading your tendons.

Specific treatments for tendonitis and inflammation may include:

Remember, the best treatment for tendonitis is not with passive modalities. You need to be engaged in an active treatment program to effectively treat your tendon problem and quickly and safely get back to your normal activity level.

Exercise for Tendonitis

Photo of a physical therapist working with a woman's knee.
Your PT can show you which exercises to do to treat your tendon problems. UpperCut Images / Getty Images

 If you have tendonitis, you may benefit from PT to help learn the right exercises to do to treat your condition. Your PT may prescribe a home exercise program that you can do. Your program may also be used to help prevent tendonitis from recurring.

One from of exercise that has been shown to help treat tendonopathy and tendonitis is called eccentric exercise. During this type of exercise, your muscle is lengthening while it is contracting. This places specific stresses upon the muscle and tendon that seem to help treat--and prevent--tendonitis. The exact mechanism of why eccentric exercise is helpful for tendonitis is not fully understood.

If you have tendonitis, your PT can teach you how to properly treat it so you can get back to your normal work and recreational activities quickly and safely.

Source: Jonsson, P. Eccentric training in the treatment of tendonopathy. Umea University, Sweden, 2009. 

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