Tendinopathy (tendonitis)

A tendon is the strong cord that links muscle to bone. In tendinopathy the tendon's structure becomes disorganised and irritated, so it tolerates load less well and becomes painful. Despite the older term "tendonitis", this is usually less about active inflammation and more about a tendon that has not adapted to the demands placed on it.

It typically develops when load outpaces the tendon's capacity to recover, often through:

• A sudden rise in training, activity or workload, or returning too quickly after a break
• Repetitive or sustained strain, including occupational and sporting demands
• Risk factors such as increasing age, certain footwear or technique, and conditions like diabetes or raised cholesterol

Less often, recurrent or multi-site tendon pain reflects an underlying inflammatory arthritis rather than overuse.

Tendon problems tend to share a recognisable pattern. Features may include:

• Pain near a tendon, often worse with use of the affected limb
• Stiffness, particularly after rest or first thing in the morning
• Tenderness, and sometimes mild swelling or thickening of the tendon
• Reduced strength or difficulty with particular movements

Tendinopathy can often be recognised from the history and examination. Confirming which tendon is involved, and the state it is in, helps guide the right treatment and rules out other causes of the pain.

Ultrasound is particularly valuable for tendons. It shows the tendon in detail, can confirm the problem and its severity, and helps direct treatment accurately. Dr Borukhson uses point-of-care ultrasound during the consultation, so the tendon can often be examined in the same visit. You can read more on the ultrasound clinic page.

The mainstay of treatment is usually a structured programme of activity modification and graded exercise to load the tendon appropriately and help it recover, alongside measures to manage pain. This approach, used consistently, is effective for most people. In selected cases an ultrasound-guided injection around the area may help, and ultrasound guidance ensures it is placed accurately. The plan is agreed with you.

Most tendon problems are mechanical, caused by overuse or strain, and settle with the right plan. Sometimes, though, tendon pain is a clue to an underlying inflammatory arthritis. This is more likely when tendon problems keep coming back, affect several different sites, come on without a clear mechanical cause, or appear alongside other features such as psoriasis, swelling of a whole finger or toe, inflammatory back pain, or a family history of these conditions.

In this situation the inflammation is often at the entheses, the points where tendons and ligaments attach to bone. This pattern, known as enthesitis, is characteristic of the spondyloarthritis family, which includes psoriatic arthritis and axial spondyloarthritis, among others. Recognising it matters, because the treatment is quite different from that of an overuse tendon problem. Ultrasound helps here too, as it can show the inflammatory changes that point towards this diagnosis, and Dr Borukhson can assess for the wider pattern during the consultation.

The aim is to keep the tendon working while it adapts, rather than resting it completely. Helpful measures include:

• Adjust load rather than stop: reduce the aggravating activity for a time, then build back gradually, keeping comfortable movement going in between
• Keep up your exercises: consistency with a graded programme matters far more than intensity, and improvement tends to come over weeks to months
• Manage pain sensibly: simple pain relief, and attention to technique, footwear or equipment, can all help
• Support your general health: addressing weight, smoking and conditions such as diabetes all help the tendon recover

Expect steady rather than instant progress, with some normal ups and downs. Most tendon problems improve well, though long-standing ones can take patience. Related conditions such as tennis and golfer's elbow and plantar fasciitis follow the same principles.

Most tendon pain is not dangerous, but some patterns warrant prompt review. Seek urgent medical attention if you have:

• A sudden snap, pop or giving way with immediate weakness or inability to use the limb, which can indicate a tendon rupture
• Loss of movement, such as being unable to push the foot down, point the toes or lift the arm
• A red, hot, swollen or very painful area with fever or feeling unwell

Outside these warning signs, it is still worth arranging a routine assessment if tendon pain persists despite sensible self-care, or if the pattern suggests something other than simple overuse, which can occasionally point to an underlying inflammatory cause such as enthesitis.

Tendon pain that is not settling is worth assessing properly, both to confirm the cause and to put in place a plan that supports recovery rather than allowing the problem to persist. If you have ongoing tendon pain, a specialist review, with ultrasound where helpful, can guide effective treatment.

How is tendinopathy diagnosed?

Tendinopathy can usually be recognised from your history and an examination, looking at where the pain is, what brings it on and how the tendon behaves with use. Because symptoms can overlap with other problems around the joint, confirming which tendon is involved helps guide treatment. Ultrasound is particularly valuable for tendons, showing them in detail and confirming the problem and its severity. Dr Borukhson uses point-of-care ultrasound during the consultation, so the tendon can often be examined in the same visit.

How long does tendinopathy take to recover?

Recovery varies with the tendon involved and how long the problem has been present, so it is hard to give a single timescale. Tendons respond gradually to loading, and steady improvement over weeks to several months is common rather than an overnight change. The key is consistency with your exercise programme and giving the tendon time to adapt. Most tendon problems improve with the right plan, and an assessment helps set realistic expectations for your situation.

What is the main treatment for tendinopathy?

The mainstay is usually a structured programme of activity modification and graded exercise that loads the tendon appropriately so it can recover, alongside measures to manage pain. Used consistently, this approach helps most people. Rest alone is rarely enough, as tendons need a degree of controlled loading to heal. In selected cases an ultrasound-guided injection around the area may help, placed accurately under ultrasound. The plan is agreed with you and tailored to the affected tendon.

How is tendinopathy different from bursitis?

Both cause localised pain around a joint and can feel similar, but they involve different structures. Tendinopathy affects a tendon, the cord that connects muscle to bone, and is often linked to overuse, so pain tends to come on with use of the limb. Bursitis affects a bursa, a small fluid-filled cushion near the joint, and often causes pain with pressure on the area. Ultrasound is helpful for telling the two apart and directing the right treatment.

When should I see a specialist about tendon pain?

Most overuse tendon problems settle with the right plan, but tendon pain that is not improving is worth assessing properly, both to confirm the cause and to put a recovery plan in place rather than letting it persist. A specialist review is especially worthwhile if the pain keeps returning, affects several sites, comes on without a clear mechanical cause, or appears alongside features such as psoriasis or a swollen finger or toe, which can occasionally point to an underlying inflammatory arthritis.