Understand chronic tendon pain and discover the best treatment options

We cover the latest research into the chronic tendon injuries commonly called tendinopathy, tendinosis, and repetitive strain injury.

Woman at computer keyboard holding painful wrist.

Chronic tendon injuries occur over time as the collagen that forms the tendons becomes increasingly abnormal. Researchers are trying to find ways to improve healing in these chronic injuries.

Male runner outside on trail holding Achilles tendon in pain.

About 16.5 million tendon and ligament injuries have been reported per year in the USA, and a great many of these injuries are chronic. If you have a chronic tendon injury, this site can help you.

If you are new to tendon pain:

The BasicsInside StoryFailed Healing

For news from the research front:

Research News

Understand chronic tendon pain and discover the best treatment options

We cover the latest research into the chronic tendon injuries commonly called tendinopathy, tendinosis, and repetitive strain injury.

Chronic tendon injuries occur over time as the collagen that forms the tendons becomes increasingly abnormal. Researchers are trying to find ways to improve healing in these chronic injuries.

Woman rests from typing on computer and holds her painful wrist.
Male runner stops on trail to hold painful Achilles tendon.

About 16.5 million tendon and ligament injuries have been reported per year in the USA, and a great many of these injuries are chronic. If you have a chronic tendon injury, this site can help you.

If you are new to tendon pain:

The BasicsInside StoryFailed Healing

For news from the research front:

Research News

Chronic Tendon Pain:
What Is Tendinosis Or Tendinopathy?

Do you have pain in a tendon that started slowly from some specific activity and became so much worse that the pain now accompanies all kinds of activities? It might burn, sting, or ache. Sometimes the pain can start without knowing what activity caused it, but usually you'll know it started from an activity such as typing, tennis, playing the drums, running, or another repetitive motion activity.  You can often tell that the pain is located specifically in a tendon, and you can point to the spot.

These chronic tendon injuries are called tendinosis or tendinopathy. These words refer to an accumulation over time of small-scale  tendon injuries that don't heal properly, resulting in a chronic injury of failed healing. Although you can't see the tendinosis/tendinopathy injury on the outside of your body, researchers can see the injury on the cellular scale by viewing slides of  tendons under the microscope. Tendinopathy can occur in many different areas, such as the wrist, forearm, elbow, shoulder, knee, and heel.

Tendons are rope-like structures that attach muscles to bones. Ligaments are similar structures that attach bones to other bones. When muscles and bones move, they exert stresses on the tendons and ligaments that are attached to them.

When your muscles move in new ways or do more work than they  can handle, your muscles and tendons can sustain some damage on a cellular scale. If the increase in demand is made gradually, muscle and tendon tissues will usually heal, build in strength, and adapt to new loads. Athletes use these principles to build muscle and tendon strength with good training programs.

You can, however, do some activity that injures a tendon on a microscopic scale and then do more injury before the tendon heals. If you continue the injurious activity, you will gradually accumulate these micro-injuries. When enough injury accumulates, you'll feel pain. This kind of injury that comes on slowly with time and persists is a chronic injury. (Acute tendon injuries, on the other hand, are sudden tears that cause immediate pain and swelling.) Tendon injuries often require patience and careful rehabilitation with physical therapy because tendons heal more slowly than muscles.

Terminology:
Tendinosis, Tendinitis, & Tendinopathy

Tendinitis: The suffix "itis" means inflammation; the term tendinitis should be reserved for acute tendon injuries accompanied by inflammation.

Tendinosis: The suffix "osis" implies a pathology of chronic degeneration without inflammation. Tendinosis is an accumulation over time of microscopic tendon injuries that don't heal properly. Although inflammation can be involved in the initial stages of the injury, it is the inability of the tendon to heal that perpetuates the pain and disability.

Tendinopathy: Tendinopathy is a term that has no implication about the pathology of the injury, so it is more general and is being used more frequently today. The role of inflammation on the cellular level in tendinopathy is currently under study and debate, but some inflammatory processes have been shown to exist.

Paratenonitis: Paratenonitis is inflammation of a thin sheath of tissue called the paratenon that surrounds some tendons, such as the Achilles.

Tenosynovitis: Tenosynovitis is inflammation of the synovial sheath that surrounds some tendons, such as the flexor tendons in the hands.

The above conditions are chronic injuries that occur slowly over time and persist, as opposed to acute injuries like tendon ruptures (partial or complete), that occur suddenly.

What Are The Risk Factors For Tendinopathy?

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Repetitive Motion

Tendinopathy can result from long hours of activities such as  playing sports, using computers, playing musical instruments, or doing manual  labor. It can result from activities performed as part of your profession or recreation. Some occupations that have increased risk for chronic tendon injuries include assembly line workers, computer programmers, writers, court recorders, data entry processors, sign language interpreters, cashiers, professional athletes, and musicians. The amount of overuse (per day, month, year) and lack of recovery time affects the severity of the injury.

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Health & Lifestyle Factors

Some health and medical conditions can predispose you to tendinopathy. If you are overweight and/or have diabetes, you have increased risk. Losing weight, improving your diet, and controlling your blood sugar can improve your tendons. Women are more prone to tendinopathy after menopause, and older people (over 60) in general are more prone than younger people. Certain collagen diseases can also predispose you (see Genetics, below). Maintaining fitness with proper training techniques can help to reduce risk. Using ergonomic tools in your daily activities also reduces risk.

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Genetics

Genetics play a factor in tendinopathy, but much more research is needed in this area. Collagen defects like Ehlers-Danlos Syndrome seem to be associated with higher risk for acute and chronic tendon injuries, and other specific genetic variants are being discovered. Here is a sampling of some research into genetic variants that seem to be associated with increased risk for tendinopathy.

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Medications

Prevention: Minimizing Your Risk

Tendinopathy usually sneaks up on you. At first, the pain only comes after a long or hard session of the activity that aggravates it. Later, the pain comes at lower levels of the activity and lasts longer. Finally, the pain becomes a part of your daily life and even normal activities can make it worse. Try to catch the injury as early as you can. Whatever your activity, you can help minimize your risk by following these tips:

  • Use equipment that has good ergonomic design and that is sized correctly for your body
  • Use good technique
  • Take plenty of breaks
  • Ovoid long overtime hours
  • Maintain healthy body weight and blood sugar levels
  • Avoid fluoroquinolone antibiotics and minimize cortisone shots
  • Listen to your body's warning signs and make changes to your routine if you experience burning, stinging, aching or tenderness to the touch in your tendons
  • If you have pain that won't go away, seek help from a specialist in tendon injuries

What To Do If You Think You Have Tendinopathy

You should see a specialist for diagnosis and treatment. Sports medicine doctors and physiatrists are often excellent choices for chronic tendon injuries, and they will likely refer you to a physical therapist. Sometimes a rheumatologist can also be helpful. You can use sites like this one to learn more about your injury and treatments for it, but you'll need a doctor to help design a program tailored to your specific case and needs..

Diagnosis

Diagnosis of tendinopathy is usually made through evaluation of medical history and symptoms, physical exam, and imaging with MRI or ultrasound.  Some statistics comparing the accuracy of ultrasound vs MRI in diagnosis of tendinopathy can be found in a summary of the 2012 second International Scientific Tendinopathy Symposium (ISTS) in Vancouver (this article also summarizes current treatments).