Tendinopathy usually sneaks up on you. At first, the pain only comes after a long 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.
Whatever your activity, you can help minimize your risk by following these preventative 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
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.
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.
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.
- Genetic risk factors for soft-tissue injuries 101: a practical summary to help clinicians understand the role of genetics and personalised medicine
- Genetic biomarkers and exercise-related injuries: current clinical applications
- The COL5A1 gene and Achilles tendon pathology
- Variants within the MMP3 gene are associated with Achilles tendinopathy: possible interaction with the COL5A1 gene
- The guanine-thymine dinucleotide repeat polymorphism within the tenascin-C gene is associated with achilles tendon injuries
- The COL1A1 gene and acute soft tissue ruptures
Four classes of prescription drugs have been associated with chronic tendon injuries: quinolones, long-term glucocorticoids, statins, and aromatase inhibitors. Antibiotics in the fluoroquinolone family (such as Cipro, Levaquin, and Avelox) have been associated with serious tendon injuries in some people. Many patients are not informed of this risk and are not given the chance to decide whether to take an alternative antibiotic. The FDA issued a warning about quinolones in May 2016, saying that their risks outweigh their benefits for sinusitis, bronchitis, and UTI whenever other treatment options can be used instead. A case study about fluoroquinolone-induced tendinopathy can be found here. Some studies have raised questions about the effects of statins on tendons, such as one study that found differences in collagen construction during healing of tendon injuries with and without statins, and one study that found changes in tendons after chronic exposure to statins, and one study that found statins have negative effects on mesenchymal stem cells; however, a systematic review of literature did not find a cause and effect relationship between statins and tendinopathy, so the jury is still out on statins.