Tendon overuse injuries (tendinopathy)

The main symptom of tendon overuse injuries is pain that gets worse when the tendon is stretched or when the attached muscle is tensed. For instance, if your Achilles tendon is affected it hurts when you stand on your tiptoes. The pain is often felt where the tendon is attached to the bone (known as tendon-to-bone insertion or enthesis).

Applying pressure to the sore tendon can also be painful. But it sometimes hurts when at rest too.

The pain often restricts movements in the affected part of your body. The sore area might also be stiff or a little swollen.

Tendon overuse injuries are usually caused by putting too much mechanical stress on the tendon. This leads to small injuries and reduced blood supply to the area. As a result, adhesions (where scarring causes tissue to stick together) and calcification (a build-up of calcium deposits) occur in the tendon tissue.

This type of mechanical overload occurs if you regularly repeat certain movements a lot during activities such as sports. For instance, swinging your arm to hit a tennis or golf ball can irritate the tendons in the elbow over time. This can lead to tennis elbow or golfer's elbow. Jogging can put too much stress on the Achilles tendon. Sports like volleyball or basketball, which involve a lot of jumping, often cause tendon problems in the knee. But tendon overuse injuries can be caused by other hobbies or your job too – for instance, if you spend a lot of time working on a computer and using a mouse.

The risk of tendon overuse injuries can also be increased by foot deformities or shoes that don't fit well. Other risk factors include diabetes, joint diseases such as rheumatoid arthritis and osteoarthritis, autoimmune diseases that attack the tendon tissue (collagenosis), smoking and being overweight. In very rare cases, tendon irritation is a side effect of medication – for instance, certain antibiotics.

The risk of tendon overuse injuries increases with age. Many people automatically rest sore tendons, and the symptoms then usually go away after a few weeks. But if you put too much strain on the tendon again after that, it may become sore again. To prevent this, experts recommend doing special exercises to strengthen your tendons and muscles.

If certain movements are often painful, you might have a tendon overuse injury. When examining the affected area, the doctor will ask whether you have done any activities (sports, hobbies or work-related) that could have placed a lot of stress on the tendon. If the symptoms can be explained by repeatedly overusing the tendon, that’s usually enough to make a diagnosis.

To be on the safe side, an ultrasound examination is sometimes done to look for other symptoms such as small calcium deposits in the tendon. X-rays or magnetic resonance imaging (MRI) scans are only needed if the doctor would like to rule out other causes.

At first, you should adjust your movements so that the symptoms do not get worse. Braces or bandages can help to relieve the strain. It is important to keep moving and not to keep the joint immobilized for too long, though. Specially targeted stretching exercises close to the affected tendon (eccentric exercises) are recommended. They strengthen the muscles and tendons, which helps to speed up recovery. It is important to increase the intensity step by step. Some patience is needed because the symptoms sometimes don’t subside until weeks or months have passed. It is possible to do these exercises as part of a physical therapy program.

Additional treatments may be used, such as massages or shock wave therapy. They have a limited effect though, if any. Painkillers may be a good option for a limited time.

If the symptoms don’t improve, doctors might suggest using steroid injections or having a surgical procedure to remove damaged tissue or break up adhesions (tissue that is stuck together). These treatments do have risks, such as inflammation or nerve damage.

It is can be difficult to avoid overuse of an arm or a leg in daily life. To reduce the strain on the tendon as much as possible, it can help to set priorities: Perhaps you can put off some more strenuous activities like washing the windows or gardening, or ask your family, friends or neighbors for help.

It is also important to know which movements are harmful and which aren't. If you’re not sure, you can ask your physical therapist to tell you which movements will needlessly strain the tendon and which ones will help the healing process along.

Athletes who are worried about staying in shape can do other types of sports that use the tendon less. It is also sometimes possible to continue doing the same type of sports, but in a different way – for instance, using a technique that is gentler on the tendon. Sports medicine doctors can offer advice here.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.