Tendonitis: what it is and how to treat it

The pain of tendonitis can be treatable, and it doesn’t have to mean giving up the activities you love. Find out more about this common condition.

You don’t have to be Roger Federer to get tennis elbow, or tendonitis. Whether you’re swinging a golf club, sitting at a computer or sweeping floors, repeating a movement over and over or stressing body parts that aren’t used to it will put strain on the tendons, and the result can be very painful.

Fortunately, tendonitis is mostly avoidable and treatable.

What causes tendonitis?

Tendonitis is caused by overloading the tendon, the tissue that connects muscle to bone. This can happen due to a sudden increase in activity, or over time as you repeat movements that affect a particular area of the body. This can put an increased load on the tendon and cause tendonitis.

If you run your hand down the back of your lower leg, from the narrow point of your calf to your heel bone, you can feel the Achilles tendon, a common place that tendonitis occurs. Other problem tendons are those near the shoulder, elbow, wrist and knee.

Sometimes the term ‘tendonitis’ is used interchangeably with ‘tendinopathy’, but although they're often related, they aren’t the same. Tendinopathy is when the collagen protein fibres that form the tendon start to deteriorate. Tendonitis is inflammation of the tendon, and often results from tendinopathy.

Sport is the most common cause, and many of the common names for tendonitis reflect this: tennis elbow, swimmers’ shoulder, golfers’ elbow, jumpers’ knee. If your job involves repetitive movement – like electricians and other labourers, musicians and surgeons – you can also be affected.

Other factors that can increase your risk of tendonitis include diabetes, smoking, genetics, taking certain medications (like steroids) and obesity.

How do you prevent tendonitis?

Don’t overdo it

Exercising regularly with proper technique, making sure you warm up and including some cross-training (which simply means mixing up the type of exercise you're doing) can help prevent injuries. But the key, says Sydney-based physiotherapist Steve Laybutt, is making sure you don’t overdo it. Maybe you’ve made the mistake of tackling a 5-hour uphill trek when the furthest you usually walk is to the shops and back.

“If you’ve got a 3-day hike coming up in 3 months, then you need to train accordingly,” Steve says. “Map it out, so by the time it comes around you’re able to build your tolerance up.”

Stick to the 10% rule

He says sticking to the 10% rule, where you increase your activity gradually, will minimise your chances of tendon injury. “If you go from running 3km three times a week to 6km three times a week, you've jumped 100%. It doesn't mean you will get an injury, but your risk is significantly increased.”

Work on your posture

When it comes to avoiding non-sport-related injuries (from sitting at a desk or practising the clarinet, for example) ergonomics and posture are important. “It might take 3 or 6 months for something to manifest, because it's progressive,” Steve warns. “You might get away with not having a great set-up for a while, but then it starts to build up the longer it goes on for.”

The main thing, he advises, is to change your position regularly and move more while you work. “The studies show there’s no perfect posture. It’s about movement. So, it might be taking breaks or doing other tasks instead of using a mouse or typing. Even if you have an ergonomic mouse and desk set-up, if you’re doing the same thing all day, it’s still repetitive strain. So it’s about mixing it up.”

How is tendonitis treated?

If you’ve been resting an injured tendon for a while and it doesn’t improve (or only does so temporarily), that’s when to get help from a health professional like your GP or a physiotherapist.

If you suspect you have injured a tendon, the sooner you get it seen to, the better. Research shows that when treated early, tendonitis takes about 6-10 weeks to resolve, but can take up to 9 months if it becomes chronic.

Treatments depend on your circumstances, but may include:

• rehabilitative exercise that might help you get moving again, regain your strength, or find new ways of doing things
• modifying your activity
• resting the injured area
• taking pain relief – nonsteroidal anti-inflammatory drugs like ibuprofen
• applying ice packs – especially after any activity that causes a pain flare-up
• having shockwave therapy, a non-invasive treatment that delivers shockwaves to injured soft tissue
• having surgery (this is considered a last resort).

Rehabilitation is about gradually loading the tendon to promote repair. “If someone just gave up running for a month, we’d probably see the symptoms resolving, but then attempts to go back to running wouldn’t be all that successful,” says Steve. “What we need to find is the right level of loading at each stage of the tendon problem. Then when the time comes that they do run, they’re ready to go.”

Pain can make you afraid to move, but Steve says the right exercises, supervised by a trained professional, can trick your brain into getting past that reluctance. They can also have a pain-relieving effect.

“It can be difficult to convince people that it’s safe to move even though they’ve got some pain. But when you can [move], that’s more powerful than any medication.”

Always consult your doctor if you’re experiencing pain. If you do have pain, don’t attempt to exercise unless you’ve sought professional advice.

Words by Mariella Attard
First published August 2021