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, your Achilles tendon 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. 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 antibiotics.

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.

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, 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. These include specially targeted stretching exercises close to the affected tendon (eccentric exercises). They can help to relax the tendon and relieve the pain.

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.

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.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your visit to the doctor.