Tendinopathy is a term used to describe a dysfunctional tendon. This can include a tendon being painful, but just because it is dysfunctional does not mean it will be painful. A tendon that is dysfunctional will often have in-growth of new blood vessels and nerves and may produce inflammatory chemicals which further irritate the tissue and nerves in that area.

Tendinopathy is often started following trauma (such as a strain), compression (such as prolonged kneeling) or overuse (often related to changes in activity/exercise). Repetition of tasks can further increase the risk of tendinopathy, but is not a guaranteed way to cause it. It normally follows the tendon being strained in a way that it cannot tolerate, causing it to enter a cycle of disrepair. 

Pain related to tendinopathy is often intermittent, but can be constant in more severe cases. Pain will often improve with periods of relative rest, but static postures may allow inflammation to accumulate and worsen pain, such as at night. Most people describe dull or aching pain, but this is not always the case. 

Common site of tendinopathies

• Rotator cuff
• Wrist extensor (aka. Tennis Elbow)
• Wrist flexor (aka. Golfers Elbow)
• Gluteal (aka. Trochanteric bursitis)
• Patella (aka. Jumpers Knee)
• Achilles 

Managing tendinopathy will often include multiple types of treatment based upon your symptoms. 

The current evidence suggests that exercise and medication should be the first line treatment if pain does not resolve with rest alone. Using medication to manage pain is important as it will enable you to use your joints more effectively and this will help the tendon repair. Exercise that is hard enough to stimulate the tendon into changing, but not so hard as to overload the tendon will help the tendon to return to a healthy way of working. 

It is also important to modify or avoid activities that cause your pain to worsen or persist as there is a good chance that this could be causing your tendon into further dysfunction.

Should these approaches fail to improve symptoms then your physiotherapist may help you consider whether injections, and in some cases surgery, may be a suitable next step. 

Q: Steroid injections will repair my tendon

A: We have no evidence that suggests this, however they can be useful for some people to manage their symptoms to enable them to use their tendon more

Q: I must have a scan to diagnose tendinopathy

A: There is little correlation between tendinopathy seen on scans and symptoms being reported by patients. Most diagnoses of tendinopathy are made on symptoms, onset, changes and a physical examination by a physiotherapist. Xrays and scans can be useful in ruling out other conditions in some cases

Q: Using my tendon is likely to damage it further

A: We have no robust evidence to suggest this, in-fact most tendinopathies improve with exercise