Tendons are the tough cords that connect muscle to bone, and they handle a lot of load as long as it rises gradually. When work, sport or a new hobby asks more of a tendon than it is ready for, it can become painful and weak. Physical Medicine & Rehabilitation of NY & CT (PMR) bases tendonitis treatment on rebuilding the tendon’s capacity with the right exercise, not simply resting it. Care is available in Danbury and Brewster, NY.
What is tendonitis?
Tendonitis means pain and reduced strength in a tendon, usually after it has been overloaded. You will also see it spelled tendinitis; the two mean the same thing. Clinicians often prefer the term tendinopathy, because tendon pain lasting more than a few weeks usually involves changes in the tendon’s structure more than ongoing inflammation. That helps explain why anti-inflammatory approaches alone often fall short.
Where tendonitis shows up
- Shoulder: rotator cuff and biceps tendons, from overhead work, throwing or swimming
- Elbow: the outer elbow in tennis elbow and the inner elbow in golfer’s elbow
- Wrist and thumb: the thumb side of the wrist, often from repetitive lifting
- Knee: the patellar tendon below the kneecap, known as jumper’s knee
- Achilles: the back of the ankle, common in runners and jumping sports
- Hip: the gluteal tendons on the outer hip
What causes it and how it feels
Most tendonitis follows a spike in load: more miles, a new sport, a heavier lift, new equipment or long hours of repetitive work. Age, diabetes, high cholesterol, inflammatory arthritis and some medications, including fluoroquinolone antibiotics, can make tendons more vulnerable.
Typical symptoms include:
- Pain when you use the tendon, often at one specific spot
- Stiffness first thing in the morning or after rest
- Pain that eases as you warm up, then returns afterward or the next day
- Tenderness to touch, and sometimes a thickened feel to the tendon
When to get urgent care for tendon pain
These signs point to something more than an overloaded tendon:
- A sudden snap or pop with immediate weakness, such as being unable to push off your foot or bend your elbow normally, may be a rupture: get seen the same day
- The area is hot, red and swollen, or you have a fever: see a physician promptly
- Tendon pain started soon after you began a fluoroquinolone antibiotic: contact your prescriber right away
- Pain in several tendons or joints at once, with swelling or a rash: see a physician
Why loading is the core of tendonitis treatment
Tendons adapt to the load placed on them. Complete rest may quiet pain for a while, but it also weakens the tendon, so pain often returns when you go back to activity. Progressive loading gives the tendon a reason to get stronger, usually in four stages:
- Settle irritability with isometric, or holding, exercises and by cutting back the aggravating activity
- Build strength with slow, heavy resistance exercises
- Add speed and spring, such as hopping, jumping or throwing, once the tendon is ready
- Return to full activity with a gradual ramp-up
Some discomfort during exercise is usually fine if it stays mild and settles by the next morning. Tendonitis physical therapy at PMR guides each progression, so you are not left guessing how much is too much.
Other treatments that can help
Shockwave for tendonitis
For tendons that are still painful after several months of consistent exercise, shockwave therapy is an option in our Brewster and Danbury locations. It is added to your exercise plan, not used instead of it, and you are screened first because it isn’t suitable for everyone.
Acupuncture and hands-on care
Acupuncture, massage and joint or soft-tissue techniques may ease pain and muscle tension so you can keep up with your exercises.
Safe self-care for sore tendons
- Reduce, but don’t stop, the activity that provokes pain
- Use ice for comfort after activity if it helps
- Avoid hard stretching of an irritated tendon, especially at the Achilles and outer hip
- Check your setup, such as racket grip, keyboard height or running shoes
- Build training or work volume back gradually
Frequently asked questions
How long does tendonitis take to heal?
A recently irritated tendon may calm down within a few weeks once load is adjusted. Tendons that have hurt for months often need three months or more of consistent loading, and some take longer. Progress is rarely a straight line and results vary, so expect good weeks and bad weeks as your tendonitis treatment moves forward.
Should I rest tendonitis completely?
Usually not. Total rest can ease pain in the short term, but tendons lose strength without load, so pain often returns when you resume activity. Relative rest works better for most people: cut back the activity that flares symptoms while doing targeted exercises at a level the tendon tolerates, then build up gradually.
Do cortisone injections help tendonitis?
A corticosteroid injection may ease pain for a short time, but it does not rebuild tendon strength, and for some tendons repeated injections can weaken the tissue. For that reason, injections are often used sparingly and paired with exercise-based tendonitis treatment. Whether one makes sense is a decision for you and a physician.
Book a tendon evaluation
PMR offers tendonitis treatment at both offices. Call or schedule online, and browse the conditions we treat for related joint and muscle problems.
- Danbury, with shockwave: PMR of Danbury, CT, (203) 744-8013
- Brewster, with shockwave: PMR of Brewster, NY, (845) 279-1135