Tendon overuse injuries (tendinopathy)

At a glance

  • The main symptom of tendon overuse injuries (tendinopathy) is pain.
  • It is usually caused by movements that are repeated a lot, for instance during sports.
  • If you have a sore tendon, you should rest it for a while.
  • After that, stretching exercises can help the tendon get used to normal amounts of strain again.

Introduction

Foto von Joggerin mit Schmerzen an der Achillessehne
PantherMedia / potalyo

If you regularly put a lot of strain on a tendon, the resulting overuse might eventually lead to pain in the tendon. It is then important to rest the sore tendon for some time. After that, certain stretching exercises are often done to gradually help the tendon get used to normal amounts of strain again.

Tendons are made up of firm connective tissue. They connect muscles to bones. Tendon overuse injuries (tendinopathies) often occur in the shoulders and elbows. In the legs, they mainly occur in the knees and in the Achilles tendons in the lower leg area. They are usually caused by repeating certain movements a lot, for instance when doing sports.

If a tendon tears suddenly (partially or completely) because it was greatly overloaded, it is called an acute tendon injury. If the soreness is mainly due to an in the tendon or surrounding tissue, it is called tendinitis (also called tendonitis) and might have been caused by a different medical problem. Examples of possible inflammation-related causes include gout, rheumatoid arthritis or a bacterial infection.

Symptoms

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, the Achilles tendon hurts when you stand on your tiptoes. The pain is often felt where the tendon is attached to the bone (known as the tendon 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.

Causes and risk factors

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 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. 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 irritation is also increased by foot deformities or wearing unsuitable shoes. 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 .

Prevalence and outlook

The risk of tendon overuse injuries increases with age. In both younger and older people, they mainly occur in the arms and legs. But athletes are more likely to have this problem in their knees and feet.

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. If you don't rest the tendon for long enough, the tendon tissue can’t recover properly. This increases the risk of the tendon becoming partially or completely torn (tendon rupture) at some point.

Illustration: Comparison of areas commonly affected by tendon overuse injuries

Comparison of areas commonly affected by tendon overuse injuries

Diagnosis

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 .

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

Treatment

At first, the most important thing is to rest the affected tendon. It is sometimes a good idea to wear a brace or bandage to help you avoid movements that put stress on the tendon. After resting the tendon for 3 to 6 weeks, people are usually advised to do physical therapy exercises to help it gradually get used to normal amounts of strain again.

Other treatments are often used too, with the aim of speeding up the recovery and relieving the symptoms. These include ultrasound therapy, massages and electrotherapy. Painkillers can be used for a limited time too.

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). But these treatments are associated with risks.

Everyday life

It is often difficult to rest an arm or a leg. To reduce the strain on the tendon as much as possible, it can help to set priorities: Strenuous activities such as cleaning windows, working in the garden or buying a lot of groceries could perhaps be postponed – or done with the help of friends, family or neighbors.

It’s also important to know exactly which movements you should avoid: Although driving a car isn’t a physically demanding activity, movements like stepping on the brakes or clutch might put too much strain on an affected tendon in that area. If you’re not sure, you can ask your physical therapist to tell you which movements will and won’t irritate the tendon. If you have a work-related tendon overuse injury, an occupational therapist can show you how to do things differently in order to avoid putting too much strain on the tendon.

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.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on March 12, 2020
Next planned update: 2023

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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