People who are over 40 years old tend to get tendonitis more than younger people, but really anyone can development symptoms depending on how damaged versus elastic tendons become. It’s true that as we age our ligaments, bones and tendons slowly weaken with everyday wear and tear, so we’re more likely to experience things like muscle or joint pain.
Tendonitis is treated in different ways depending on where it’s located on the body, how long it’s been present and the person’s physical activity level. If you visit an orthopedic or doctor to help treat your tendonitis, he or she might prescribe a treatment plan involving getting plenty of rest, taking time off from exercise, using ice/heat packs, attending physical therapy, or taking pain-killing and anti-inflammatory medications.
Most of the time drastic measures like having surgery performed or getting ongoing injections aren’t needed, but in the case where a tendon ruptures, these can be used to manage the situation quickly. Learn about tendonitis symptoms, causes and what you can do the help alleviate tendonitis pain.
What Is Tendonitis?
Tendonitis (which is also sometimes spelled tendinitis) is a form of painful inflammation in the tendons, which are the chord-like parts of the body that connect muscles to bones. Usually caused by repetitive movements (like exercise or sitting in the same position for many hours), injuries or built-up inflammation over time, tendonitis can cause a lot of pain.
Tendonitis comes down to experiencing inflamed tendons that are more susceptible to stress, strain, movement and tears. Despite what most people assume, this can affect people of all ages, sizes and physical activity levels, not just serious athletes or the elderly.
Is tendonitis the same as tendinopathy? Not quite, as tendinopathy is a broader term that encompasses painful conditions occurring in and around tendons in response to overuse, and it usually means a degeneration of the collagen protein that forms the tendon. Tendonitis, meanwhile, is simply inflammation of the tendon. Both are painful conditions to deal with.
Signs and Symptoms
Tendonitis symptoms can vary in terms of how long they last, some healing within a couple weeks with others lasting for more than a few months. It really all depends on how severe your injury is, how long it’s been going on and how much inflammation has developed.
The sooner you address the problem, rest and seek treatment, the quicker you should be able to see symptoms subside.
Some of the common areas of the body where tendonitis can develop include the knees, shoulders, heels, elbows, wrists, hips and hands. Different types of tendonitis go by various names depending on how and where they form. For example:
- Tennis elbow
- Golfer’s elbow
- Pitcher’s shoulder
- Swimmer’s shoulder
- Jumper’s knee
Some common signs indicating that you might have tendonitis include:
- feeling pains and aches around a specific ligament, joint or muscle
- swelling and tenderness
- increased pain when moving or exercising
- trouble sleeping due to pain
Because repetitive movement is one of the most common causes of tendonitis, everyday activities like typing, cleaning, running or playing sports can trigger its development. In fact, even though an injury can kick-start the development of tendonitis, usually it’s someone’s job or hobbies that mainly cause the problem. This is especially true when someone begins these activities abruptly (like a workout plan, for example) and does too much too soon.
Some of the many activities that can cause tendonitis to form include:
- Sitting at a desk with incorrect posture
- Jogging/running (which affect the heels)
- Not stretching after exercise
- HIIT workouts and other forms of sprints (especially when you haven’t properly warmed up or rested enough)
- Basketball (one of the causes of “jumper’s knee”)
- Cycling or using the elliptical machine
- Working with your hands for many hours every day (including carpentry, cleaning, shoveling, etc.)
- Baseball (throwing and pitching affects the shoulder)
Don’t get the wrong idea just yet — the risk for developing tendonitis isn’t an excuse to avoid exercise and being active! These activities aren’t the only things that can trigger your tendons to become inflamed.
Poor posture and certain abnormal bone or joint developments, like having legs or arms that are not equal in length, can also set the stage for tendonitis.
In some cases, older people can form tendonitis after bracing themselves during a fall, which triggers inflammation in the joints or tendons. Because tendons are chords of “fibrous” tissue, really any type of stressful movement or internal infection or cause of swelling can strain them to the point of injury.
While there are hundreds of tendons throughout our bodies, only a number of specific ones seem to cause the vast majority of tendonitis cases. That’s because these tendons are used the most in everyday life and also might receive less blood flow.
Poor blood supply and difficulty getting nutrients to tendons can contribute to tissue damage and inflammation, which is why it’s important to do what you can to improve circulation, nutrient intake, blood pressure levels and bodywide inflammation.
Diagnosis of tendonitis typically only requires a physical exam. To rule out other conditions that might be behind symptoms, X-rays or other imaging tests might be used.
The overarching goals of tendonitis treatment is to relieve pain, reduce irritation and return the person to their normal activities. However, recovery can often take several months.
For many tendonitis sufferers, self-care that includes rest, ice and pain relievers is all that’s needed. If you’re an athlete or someone who regularly exercises, you might be disappointed to hear that many people need to take time off from the gym, group sports and other workouts in order to let their tendons fully heal.
Your healthcare provider can try and pinpoint which type of activity could have contributed to the development of your tendonitis — such as running or tennis — so you know that it’s best to at least temporarily stop doing that activity.
How long do you need to rest and hold off exercising? This all depends on which tendon is affected and how severely its inflamed, but experts typically recommend a rest period of about three to six weeks.
You actually don’t want to rest for too long, since this can leave your tendons stiff. Try to give yourself enough time to heal so you notice pain and swelling has gone down. Aim to gradually restart exercise when your pain allows, remembering to keep things at a low intensity for a while, stretch and take breaks regularly.
If you do continue to stay active in some sort of low-intensity way, make sure to avoid any activities that cause your pain to get worse. If you continue to exercise in a way that strains your tendons, you’re only doing further damage and ultimately prolonging the period it’s going to take to solve the problem.
2. Ice and Then Heat
Within the first three days of the tendonitis injury/pain, icing the area for 15 to 20 minutes every four to six hours can help reduce both pain and swelling. Common area of tendonitis pain include the shoulders, elbows, wrists, knees and heels (Achilles tendons). Place a towel or cloth between the ice pack and the skin.
Remember, however, that icing these areas does not speed up healing. After those initial three days, consider using heat instead, as it can be more effective for chronic tendonitis pain.
Heat tends to increase blood flow and help promote healing of the tendon area. It also can relieve pain by relaxing the muscles.
Heat packs or heating pads can work well but it shouldn’t be overly hot and painful to the touch. Often 15 to 20 minutes can suffice but also consider longer sessions, such as a warm bath or sauna, that can work better for severe pain or stiffness.
There are many types of pain relievers, including aspirin, ibuprofen and acetaminophen. There are also creams that can be applied to the skin. These products may help relieve pain. One study pointed out that while NSAIDS and corticosteroids (see below) appear to provide pain relief in the short term, their effectiveness in the long term has not been demonstrated.
4. Corticosteroid Injections
Sometimes a healthcare professional might recommend that a patient gets steroid injections to help quickly reduce pain and swelling. Generally, this isn’t a good method for preventing or treating tendonitis long-term, but it can be a quick-fix solution when the injury is severe enough.
Injections do come along with some side effects sometimes, like changes in skin color, weakening the tendon and causing increased swelling. Most people need to wait six weeks or more between injections, so in this time period it’s important to focus on solving the problem by addressing other factors like rest and recovery.
5. Physical therapy
Some people choose to try physical therapy for tendon injuries, which involves seeing a specialist who works with you to prescribe special isolated movements. The goal of physical therapy is to slowly start stretching the injured tendon in a controlled matter, while increasing flexibility and strength in the supporting muscles around the tendon.
6. Extracorporeal Shock Wave Therapy (ESWT)
Some healthcare providers might recommend you try ESWT, especially if you have tried other remedies and are still experiencing persistent symptoms. ESWT is a low-pain treatment that sends shock waves through your skin to the tendon in order to help break up deposits that have built up. Like injections, this comes with side effects and shouldn’t be your first choice of treatment.
Surgery is another option but considered a last resort, as it carries complications like side effects to anesthesia and medications, infections, scarring, and rupturing the tendon. Arthroscopy is one type of popular surgery performed on people with “tennis elbow,” a common type of tendonitis, that is said to result in less recovery time since it isn’t as invasive as other forms of surgery.
1. Start New Exercises Slowly and Take Enough Rest Days
One of the common triggers for tendonitis is beginning an exercise routine too quickly or failing to take enough rest between workouts. Overworking the body and running down your immune system can cause inflammation levels to go up, which sets the stage for tendon, muscle or joint injuries to development.
This not only causes ongoing pain, but it can stop you right in your tracks, forcing you to give up most forms of activity for a period.
Your tendons need time to catch up with any new form of movement and activity, so start slowly with anything that you’re not used to normally doing (like yoga, sprinting, cycling or knee-strengthening exercises, for example). Even if you’re a seasoned athlete or have been doing regular exercise for years, make sure you still take recovery/rest days.
Rest between workouts is crucial for allowing enough time to go by for your worn-down tissue to repair itself. In fact, in between workouts is when we actually grow stronger, not while we’re doing them.
2. Follow an Anti-Inflammatory Diet
Like nearly all injuries and even diseases, chronic inflammation only makes matters worse. The foods you put into your body can have a drastic impact on your overall inflammation levels, some helping you heal more quickly and prevent injuries, while others trigger swelling and delay recovery.
Some of the most healing anti-inflammatory foods that you want to regularly eat include:
- All types of vegetables, especially green leafy kinds — Veggies are loaded with antioxidants that fight oxidative stress, one of the primary causes of inflammation. Try to make half your plate cooked or raw veggies with every meal, aiming to regularly include kinds like kale, broccoli, spinach and other greens. Leafy and cruciferous vegetables are especially high-antioxidant foods loaded with vitamin C, vitamin K and minerals that speed up the healing process.
- High-quality “clean” proteins — Protein is important to helping repair broken-down tissue throughout the body, so protein deficiency can cause weakness, delayed recovery, fatigue and bodily pains. A good rule of thumb is to try to get at least four to five ounces of quality protein per meal. Some of the best choices, which include the most easily utilized amino acids, are organic, lean proteins like wild-caught fish (a great source of anti-inflammatory omega-3 fatty acids), raw dairy, cage-free eggs or grass-fed beef. Another benefit of these foods is that most pack in zinc (found in high levels in beef, pumpkin seeds and spinach), and zinc benefits include tissue development and repair.
- Berries — Berries are packed with vitamin C that helps with rebuilding collagen, an essential component of tissues. Other vitamin C foods include citrus fruits, squash, green veggies and bell peppers. Berries are also a great source of antioxidants that fight free radical damage, one of the causes of increased injuries into older age. Pineapple is another great fruit choice because it supplies bromelain, a compound great for treating swelling and injuries.
- High-potassium and magnesium foods — Potassium-rich foods like coconut water, avocados, greens and bananas can speed healing. Magnesium found in these same foods is also important for muscle recovery, healthy circulation and helping you get good rest.
- Bone broth — Bone broth naturally contains collagen, which is beneficial for healing tendons, since it’s actually what helps develop and form tissue within the body. Not only is it useful for tendonitis cases, but it can also aid in recovery from sprains, strains and ligament injuries.
On the other hand, these foods can increase inflammation and make tendonitis worse:
- Alcohol and caffeine — Alcohol can prolong inflammation and promote bone loss, as can caffeine that contains certain compounds that bind to calcium. We need calcium to help heal tissue that’s been damaged, so this can stall your body from properly repairing itself — so avoid caffeine overdose, and limit alcohol consumption.
- Too much sodium and salt — Sodium (found in nearly all packaged foods) counteracts potassium, and too much contributes to the loss of important nutrients from your body that are needed to facilitate the healing process, so avoid high-sodium foods as much as possible.
- Sugar and refined grains — High levels of added sugar can decrease immune function, slow down wound healing and increase inflammation, not to mention contribute to unwanted weight gain, which can make tendonitis symptoms worse. That means you want to kick that sugar addiction to help treat your tendonitis.
- Hydrogenated oils and fried foods — Just like with sugar, refined oils are found in processed foods and are known to cause inflammation since they are a source of “pro-inflammatory” omega-6 fatty acids.
3. Consider Wearing a Splint or Brace
Adding some extra support around your tendons — by wearing a bandage, splint or brace, for example — can help make sure you keep the affected body part from moving too much. Isolating the tendon that’s inflamed helps reduce swelling and supports healing of the damaged tissues.
4. Alternative Treatments
A number of different soft tissue therapies may be able to help treat the underlying causes of tendonitis as well. Consider visiting a trained practitioner (such as a physical therapist) in one of the following manipulative therapies, which have been shown to help eliminate joint and/or muscular pains and help people overcome injuries:
5. Helpful Supplements
To give your immune system a boost, lower inflammation and nourish damaged tissue, you can try these supplements that fight pain and swelling:
- Omega-3 fish oils — These anti-inflammatory fats are needed for wound healing, controlling swelling and proper immune responses. Aim for four grams daily between eating wild-caught fish or seafood and taking supplements.
- Collagen/collagen protein — Both tendons and ligaments are largely made of collagen, so taking this in supplement form helps restore your supply and strengthen weakened areas.
- Bromelain — This enzyme is found naturally in pineapple and has anti-inflammatory effects. It can work for reducing acute or chronic joint pain. One research trial evaluated 42 osteoarthritis patients with degenerative spine or painful joint conditions and who were given two 650-milligram capsules of bromelain, two to three times each day on an empty stomach. Researchers discovered that pain decreased up to 60 percent in participants dealing with acute pain and more than 50 percent in those with chronic disorders.
- MSM — A well-researched MSM supplement benefit is that it helps decrease joint inflammation, improves flexibility and restores collagen production. It can help form connective tissue and repair joints, tendons and ligaments. It also works well for treating aches, like ongoing shoulder or back pain.
- Chondroitin and glucosamine — Even for people without osteoarthritis, there’s evidence suggesting that chondroitin used with glucosamine helps preserve valuable cartilage, decreases pain, increases physical function and enhances self-care activities.