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Tennis elbow, jumper’s knee, pitcher’s shoulder—the nicknames for tendonitis let you know it’s a sports injury. Even so, tendonitis can happen to anyone doing just about anything. Fortunately, tendonitis usually heals if the tendon is given enough rest and care, but this could take some time. So the best medical advice to patients with tendonitis is to be patient.
What is tendonitis?
Tendonitis (or tendinitis) is tendon damage due to stress on the tendon due to sudden movement or repetitive overuse of the tendon. The injury immediately swells, causing pain and limiting the function of the tendon. Healing a tendon is a long, complex process that usually completes in about six weeks, but could take several months.
Tendons are tough, fibrous tissues that connect muscle to the bone. In lifting, running, and other activities, tendons bear most of the stress when muscles pull on the bone. Tendons also store energy like a spring. They can be compressed and then quickly release the energy from that compression. Running, jumping, accelerating are all made possible by tendons releasing compressed energy.
Tendonitis can happen to any tendon in the body, but tendons that are subject to heavy loads or overuse are the most common site of tendon injuries:
- Achilles tendonitis: The Achilles’ tendon attaches the calf muscle to heel bone.
- Patellar tendonitis (jumper’s knee): The patellar tendon connects the kneecap (patella) to the calf bone (tibia) and is used when the thigh muscle straightens the leg.
- Medial epicondylitis (golfer’s elbow or thrower’s elbow): Golfer’s elbow develops from overusing the tendon on the inside of the elbow.
- Lateral epicondylitis (tennis elbow): The lateral epicondyle connects forearm muscle to the upper arm bone.
- Supraspinatus tendonitis (swimmer’s shoulder or pitcher’s shoulder): Overuse of the rotator cuff tendon injures the tendon.
- De Quervain’s tenosynovitis (gamer’s thumb or Nintendonitis): Overuse of the wrist can injure the two tendons at the base of the thumb.
Healthcare providers distinguish between tendonitis (a sudden injury to and swelling of the tendon) and tendinosis (a degeneration of the tendon fibers, usually from overuse). Healthcare professionals sometimes call tendinosis “chronic tendonitis.” Tendonitis and tendinosis are closely related. Sudden injury of a tendon (tendonitis) usually happens because the fibers have already degenerated (tendinosis) from previous injuries or repetitive overuse, such as in tennis elbow, gamer’s thumb, and swimmer’s shoulder.
How is tendonitis diagnosed?
Diagnosis of tendonitis is usually made with a medical history and a physical examination.
In the first visit, an orthopedist or primary care physician will try to determine the nature of the injury. Be prepared to answer the following questions:
- When did the pain start?
- Did the pain result from a specific incident?
- What activities cause the pain?
- Does the pain get worse during activities?
- Has that area been injured or painful before?
- What prescription medications are being taken?
Tendonitis is most commonly caused by either overloading or overusing a tendon. Lifting a heavy load, fast weight lifting, running, or moving suddenly can overstress and fragment fibers in part of a tendon. Throwing, swimming, playing tennis, or using a computer mouse can slowly damage a tendon until it starts to swell and hurt. Finally, some medications, such as fluoroquinolone antibiotics, can damage tendons.
People most at risk for tendonitis are athletes, sports participants, and people who engage in any activity involving repetitive motions. Because tendons stiffen as people grow older, age increases the risk of tendonitis. Conditions such as rheumatoid arthritis, high cholesterol, and diabetes also raise the risk.
In a physical exam, a healthcare professional will look for swelling and test range of motion. An X-ray may be ordered if the physician suspects another condition may be causing the pain, such as a tiny bone fracture.
For repetitive tendon injuries or tendinosis, a healthcare provider may order an MRI or ultrasound to assess the full damage to the tendon.
Tendonitis treatment options
The goal of tendonitis treatment is to eliminate the pain and return the tendon to its normal function. The most common treatment to achieve these goals is to rest and exercise the tendon. More severe tendon damage or chronic tendonitis may require other treatments to manage the pain or restore tendon function.
Rest
The near-universal treatment for tendonitis is to rest the tendon. Reducing the stress put on the tendon prevents further damage and allows the tendon to heal. Rest will require a complete break from the exercise, sport, or activity that caused the injury for a few days or weeks. Ice, compression, and over-the-counter NSAIDs can help manage the pain and swelling.
Exercise
Rest alone is not sufficient. In fact, too much rest will prolong the problem. To both restore tendon function and reduce pain, a graduated series of exercises strengthen the tendon. Patients will start with eccentric exercises and stretches; these are exercises that both stretch and contract muscles and tendons, like slowly lowering rather than lifting a weight. Eventually, exercise will include isometric and other exercises to fully restore tendon function.
Medications
Tendonitis medications relieve pain and swelling. In most cases, over-the-counter NSAIDs provide sufficient pain relief, but injectable corticosteroids may be used for severe or debilitating pain.
Platelet-rich plasma
Platelets in the blood release growth factors that promote healing in injured tissue. Platelet-rich plasma (PRP) is the patient’s blood that has been centrifuged so that it has a higher than normal concentration of platelets. It is then injected as a gel onto the damaged tendon to speed up the tendon healing process. Although commonly used in sports medicine, the results are mixed.
Shockwave therapy, laser light therapy, and sclerotherapy
Some orthopedic specialists use extracorporeal shockwave therapy (ESWT), low-level laser light therapy (LLLT), or sclerotherapy to treat tendonitis pain. ESWT sends a high-energy sound wave at the tendon and may work by killing nerves in the tendon. LLLT directs a low-level laser beam at the skin above the tendon. Finally, sclerotherapy uses drugs to kill the extra blood vessels and nerves that have formed in the damaged tendon. All of these therapies can reduce pain in some patients, but may not speed the healing process.
Surgery
Surgery is the treatment of last resort for chronic tendonitis. An orthopedic surgeon will remove injured or scarred tissue from the damaged tendon and may graft collagen tissue on the tendon to protect the tendon and help it heal.
Tendonitis medications
Medications are used to treat the symptoms of tendonitis: swelling and pain. Most people can achieve adequate pain relief during the healing process by using cryotherapy, either ice packs or ice massage, or over-the-counter NSAIDs such as aspirin or ibuprofen.
NSAIDs (Non-steroidal anti-inflammatory drugs)
NSAIDs reduce the swelling and pain in the tendon. Over-the-counter oral or topical NSAIDs, such as ibuprofen, naproxen, aspirin, or trolamine, adequately manage pain during the recovery process. More severe pain can be treated with prescription NSAIDs such as diclofenac or indomethacin.
Corticosteroids
More severe or chronic tendon pain will be treated with a corticoid steroid injection. Corticosteroids, such as methylprednisolone or cortisone, are prescription-strength drugs that rapidly reduce swelling. Pain relief is usually immediate and can last for up to six weeks.
What is the best medication for tendonitis?
Tendonitis medications relieve pain and swelling. So, if a patient can relieve pain and swelling through resting and icing the tendon, then the best medication is no medication at all. If not, the most commonly used medications for tendonitis pain relief are over-the-counter oral or topical NSAIDs. However, the best pain reliever for one person may not work for others.
| Best medications for tendonitis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Motrin (ibuprofen) | NSAID | Oral | Two tablets every four hours | Nausea, bleeding, stomach pain |
| Aleve (naproxen) | NSAID | Oral | One 220 mg tablet taken with food or water every 8 to 12 hours | Nausea, bleeding, stomach pain |
| Aspirin | NSAID | Oral | One or two 325 mg capsules or tablets with water per day | Upset stomach, heartburn, bleeding |
| Myoflex (trolamine salicylate) | NSAID | Topical | Apply to the affected area three to four time a day | Nausea, upset stomach, skin irritation |
| Depo-Medrol (methylprednisolone acetate) | Corticosteroid | Injection | 1/16 to 3/8 ml injection of 80 mg/ml solution | Mood changes, edema, increased blood pressure, high blood glucose, weight gain |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of tendonitis medications?
There are several common side effects of tendonitis medications, and different classes of medications have different side effects. However, this is not a complete list, and you should consult with your healthcare professional for possible side effects and drug interactions based on your specific situation
NSAIDs provide only temporary pain relief but give the illusion of having fixed the underlying condition. As a result, the most serious side effect of NSAIDs for people with tendonitis is engaging in physical activities that worsen the injury. Other side effects may include stomach problems, ulcers, gastrointestinal bleeding, bruising, and bleeding problems.
Corticosteroid injections will produce side effects in many people, including mood and behavior changes, increased appetite, weight gain, acne, thinning skin, a rise in blood pressure and blood glucose levels. Long term steroid use can lead to adrenal funciton suppression which can result in very low blood pressure. Like NSAIDs, the most serious side effect of corticosteroids is resuming activities that will interfere with healing or worsen the tendon injury.
What is the best home remedy for tendonitis?
Although the evidence is mixed about most medical treatments for tendonitis, it is universally agreed that the best remedy for tendonitis is rest and graduated exercise to strengthen the tendon. Pain and swelling can be managed by ice, compression, and over-the-counter pain relievers.
Rest the injured area by halting activities that caused the tendon injury, whether running, playing tennis, or typing. Do not put any strain on the tendon with other activities, such as heavy lifting or unnecessary walking.
The tendon requires exercise to build strength and elasticity. In the early weeks after a tendon injury, the best exercises are eccentric exercises and stretches. Eccentric exercises both contract and stretch the muscle and tendon, such as lowering rather than raising a weight. As the tendon heals, introduce isometric exercises as long as there is no pain.
For acute tendonitis or pain flare-ups, pain and swelling can be managed by applying ice packs or massaging the tendon area with ice. However, for chronic tendinosis, a heating pad should be applied rather than ice.
Use a compression bandage or tape to limit the movement of the joint. You will need to move the joint to prevent the tendon from becoming stiff, but compression will help the tendon to rest and heal.
Frequently asked questions about tendonitis
Will tendonitis heal on its own?
A damaged tendon may not fully heal, but it can be restored to pain-free full function with rest and exercise.
How do you treat tendonitis?
Tendonitis is primarily treated with rest and gradually-increasing exercise. Pain and swelling can be adequately managed in most cases with ice or over-the-counter NSAIDs such as aspirin or ibuprofen.
How long does it take for tendonitis to heal?
Depending on the injury and how soon it is diagnosed, tendonitis usually takes four to six weeks for the tendon to be restored to full function. Recovery from more severe damage may take months. Some cases of chronic tendinosis may not ever fully resolve.
How do you heal tendonitis fast?
The healing process for tendonitis is long and complex. Tendon cells must first generate new tissues, create new fibers, and then organize the fibers into a strong matrix. This process can take weeks or even months depending on the injury. The best treatment for tendonitis is patience. Rest the tendon, stretch the tendon, and perform graduated daily exercises to build strength and flexibility in the recovering tendon.
Is heat or cold better for tendonitis?
For an initial tendon injury or flare-ups, ice packs or ice massage can reduce swelling and relieve pain. For chronic tendinosis, swelling is not an issue. Applying heat to the area increases blood flow and relaxes the muscles, both of which can reduce the pain.
Is massage good for tendonitis?
Transverse friction (or deep friction) massage has been traditionally used for tendonitis and other soft tissue injuries. Although practitioners, chiropractors, and some physical therapists believe it speeds the healing process, results are only anecdotal. It does, however, provide significant pain relief, so it’s worth a try.
What is the best therapy for tendonitis?
For tendonitis, the goal of therapy is to restore the tendon’s function and manage pain. The near-universal therapy for restoring tendon function is rest and physical therapy involving daily stretching and exercise to increase the strength and flexibility of the tendon. Cryotherapy (icing) and over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) can sufficiently manage the pain in most cases.
What foods are good for tendonitis?
Nutrition plays a role in health and healing, so a nutritional diet is always a good idea. However, there are no conclusive studies linking diet or supplements to tendonitis recovery. The basic process in tendonitis healing is collagen fiber production and organization in the tendon. Nutrients such as Vitamin D, Vitamin E, amino acids, glucosamine, and chondroitin are instrumental in collagen fiber formation, but it is uncertain if they can speed up or improve tendonitis recovery.
What happens if tendonitis goes untreated?
If tendonitis is not treated with rest, the condition will worsen as damage builds up in the tendon. The pain will increase as more nerves and blood vessels grow into the tendon fiber. A damaged tendon is at risk for rupture, a condition in which the tendon tears, breaks, or is separated from the bone.
What is the best cream for tendonitis?
Mild tendonitis pain can be effectively managed with topical NSAID creams such as Myoflex or Aspercreme.
Does tendonitis ever go away?
In most cases, adequate rest and gradual exercises will eliminate tendonitis pain and restore the tendon to full functioning.
Can you work with tendonitis?
If tendonitis is due to repetitive work movements, those movements should be dramatically reduced for the tendon to heal. At first, these movements should be completely avoided for a few days. They can be started for short periods of five to ten minutes with fifteen- to twenty- minute breaks. A full return to performing repetitive work tasks will not happen until the overuse injury is fully healed, usually four to six weeks.