What is Tendonitis and How to Treat It

Did you know that approximately 33 million musculoskeletal injuries are reported in the United States each year and that 50% of them involve tendon and ligament injuries? (9) Keep reading to learn more about tendonitis and how to treat tendinitis with the help of a qualified healthcare provider.

Tendons connect muscles to bones and transform the force that’s generated by muscles into movement. (9) In fact, tendons help individuals comfortably perform some of their favorite activities such as playing tennis, typing on the computer, walking, and many others. With age, tendons become more susceptible to degeneration, and in turn, injuries such as tendonitis may occur. Nutrition and genetics also play a part in the health of tendons. (9)

What is tendonitis?

Tendonitis, also spelled tendinitis, is a type of tendon pain. Tendonitis is characterized by swelling and inflammation of the tendon. (8)

Tendons, a type of connective tissue that connect muscles to bones, are composed of densely packed collagen fibers with an extracellular matrix (ECM). They are found in several areas of the body including the elbows, wrists, knees, shoulders, and heels (e.g., achilles tendon). (8)

Achilles tendonitis is a type of tendonitis that occurs in the achilles tendon, a band of tissue that connects the calf muscles to the heel bone. (8)

Tendonitis results from micro-tears that may occur following an acute injury or due to repeated micro-tears that occur over time. (1) It’s not uncommon for individuals such as athletes, musicians, carpenters, or other groups to experience tendonitis.

Tendonitis symptoms may include:

• Localized tendon pain
• Tendon swelling
• Warmth

Did you know? Tendonitis was once used to describe many different types of tendon pain; however, it’s currently used to describe acute inflammation of the tendon. (1)

How to treat tendonitis

Tendonitis treatment recommendations should be offered by a qualified healthcare provider and will differ depending on the type of tendon injury diagnosis that’s received. Integrative and natural remedies for tendonitis inflammation and pain may include:

• Applying compression to the injury site
• Applying ice packs for sudden, serious injuries
• Elevating and resting the affected area
• Reducing activity levels to prevent further injury
• Stretching and strengthening exercises
• Taking certain medicines (e.g., pain relievers, anti-inflammatory medications) to help reduce pain and swelling
• Using a splint, elastic bandage, or brace (8)

Tendons have the ability to fully or partially heal through a process that’s controlled by tendon cells and the surrounding extracellular matrix. (9) The stages of this process include:

1. Tissue inflammation
2. Cell proliferation
3. ECM remodeling (9)

Did you know? Surgery may be recommended for a fully torn tendon injury. (8)

Tendonitis vs. tendinosis treatment

Tendinopathy is an umbrella term that’s used to describe several tendon disorders such as tendonitis and tendinosis. Although the terms tendonitis and tendinosis sound alike, they differ in several ways. Unlike tendonitis, tendinosis is a non-inflammatory condition, involves degenerative changes to the collagen molecules of the tendon, often results from repeat strain injuries, and usually takes longer to heal than tendonitis. (1) The treatment recommendations for these two conditions may also differ. The following table outlines these differences in more detail.

This table outlines differences between tendonitis and tendinosis. (1)(8)

Did you know? Tendinosis rarely involves tendon inflammation and, more often than not, occurs before tendonitis. (1)

Other tendon disorders characterized by inflammation and pain include:
Peri-tendonitis: inflammation of the sheath that surrounds the tendon
Retrocalcaneal bursitis: inflammation in the bursa located between the achilles tendon and heel bone (9)

Tendonitis (inflammation) and tendinosis (degeneration) are distinct tendon injuries with different symptoms and effective treatment methods that may overlap. (1)

Factors that influence tendon health

Several different risk factors including activity level (e.g., overuse) can affect the health of our musculoskeletal system including the tendons. Aging, nutrition, and genetics may also influence tendon health, specifically tendon degeneration. Tendinosis (tendon degeneration) is thought to precede tendonitis. (1)

1. Aging

As we age, our tendons may become more prone to injury as a result of tendon degeneration. (9) When there’s an imbalance between ECM decomposition and synthesis, the ECM may fail to adapt. This process of degeneration can be caused by different stressors including repetitive movements and mechanical loading over time.

There are three main hypotheses that seek to explain tendon degeneration:

• Mechanical overuse and repetitive motions
• Less vascularisation (i.e., micro damages from injury may negatively affect blood supply that help a tendon heal)
• Aging (3)(9)

2. Nutrition and supplements

Diet contributes to the health of all body tissues, and optimal nutrition may be helpful for preventing and addressing a tendon injury. (5)

Consuming enough water, macronutrients, and micronutrients is necessary to maintain healthy body tissue:

• Macronutrients include proteins, lipids, and carbohydrates
• Micronutrients mainly include vitamins and minerals (5)

Macronutrients and micronutrients are necessary for maintaining healthy body tissue.

While more well controlled clinical research studies are necessary, the following supplements may be associated with benefits to tendon health and tendonitis:

• Curcumin
• Boswellic acid
• Bromelain
• Hydrolyzed collagen (type 1)
• L-arginine
• Methylsulfonylmethane (MSM)
• Vitamin C
• Vitamin D (4)(5)

For example, vitamin C is a cofactor in different stages of collagen synthesis in the body, and a deficiency may affect collagen synthesis in the ECM in tendons. (2)(5) In North America, a vitamin C deficiency is rare; however, if an individual is malnourished, undergoing chemotherapy, or drinks alcohol in excess, they may become deficient. (5)

3. Genetics

Certain genetic connective tissue disorders that affect bone, skin, muscle, tendons, or ligaments such as Ehlers-Danlos and Osteogenesis Imperfecta may be associated with tendon disorders. (6)(7) However, genetic diseases are not directly associated with tendon injuries. (9)

Did you know? Certain conditions, such as gout, a type of arthritis that typically occurs in the lower limbs, may be associated with tendon disorders. (5)

Can tendon pain be prevented?

The following methods may help prevent tendonitis:

• Avoid sitting for long periods and maintain good posture.
• Begin slowly when trying a new physical activity.
• Consider using gloves or other padding to increase the grip on tools or instruments (e.g., golf clubs, tennis racket).
• Cushion the affected joints (e.g., elbow pads, foam for kneeling).
• Do a warm-up and stretch before exercise.
• Do not participate in activities that cause pain.
• Practice strengthening exercises for the joints and surrounding muscles.
• Take breaks from repetitive activities.
• Use two hands to hit a backhand in racket sports or when using heavy tools. (8)

Did you know? Sports that involve repetitive motions can lead to tendonitis. Tennis elbow and golfer’s elbow are two examples of tendonitis. (8)

The bottom line

Tendonitis is characterized by swelling and inflammation of the tendon accompanied by pain that occurs at the site of the affected tendon. Tendon injuries including tendonitis are common, and luckily there are methods to help you fully or partially recover from them and reduce pain.

Tendonitis recovery methods may include applying compression, elevating the injury site, rest, ice (to reduce inflammation), massage, or stretching and strengthening exercises to promote the healing process. Aging, nutrition, and genetics may also play a part in tendon health. Always speak with a qualified healthcare professional about your tendon injury symptoms to ensure that you receive an appropriate diagnosis and recovery plan and to determine if surgery or other treatments may be necessary.