Tendinopathy – Causes, Symptoms & Treatment


Tendinopathy is a non-inflammatory disease of a tendon or tendon insertions . The disease can be traced back to overloading, incorrect loading or degenerative processes in the tendon and does not belong to the diseases of the rheumatic type. Depending on the stage of the tendinopathy, pain occurs only after physical activity or at the beginning, during and after (sporting) activity.

What is tendinopathy?

Tendinopathy – also called tendinopathy – is a non-inflammatory, painful disease of a tendon or the attachment of a tendon near the joint If the tendon attachments are affected, this is known as insertion tendinopathy or enthesiopathy .

The disease can reach several degrees of severity, the classification of which is primarily based on when the pain becomes noticeable. At the mildest level, pain occurs after the completion of a specific activity. At the most severe level, the pain occurs at the beginning, during and after the end of the activities.

Depending on the sport practiced, tendinopathies most commonly develop on the shoulder, elbow, hand, hip and lower extremities. The disease must be differentiated from other inflammatory tendon diseases such as tendonitis (tendonitis), tennis elbow (epicondylitis radialis humeri) and other painful tendon diseases.


The causes of the non-inflammatory diseases of the tendons are mostly in the incorrect and overloading of certain muscle parts. Unfavorable throwing or running techniques as well as selective, static overloading, such as when lifting weights, are often responsible for the development of tendinopathy. Static or dynamic excessive stress on the tendons and tendon attachments can cause microruptures or friction, which can be regarded as causing symptoms.

Overloading is often due to a muscle imbalance, blatant postural errors or a BMI that is too high . Athletes who intensively practice jumping sports or ball sports that involve extremely quick changes of direction are particularly at risk. These include ball sports such as volleyball, handball and basketball.

Symptoms, Ailments & Signs

The first signs and symptoms that indicate the onset of tendinopathy is a gradually increasing sensation of pain during heavy exertion or after completing a range of motion training. In some cases, the pain can appear suddenly. In addition, typical start -up pain similar to osteoarthritis can develop in the morning .

If the shoulder or arms are affected, pain can also occur at rest because the affected areas are sensitive to pressure. The affected tendon often swells, mainly near the joint where the tendon was inserted. If the disease progresses untreated and the pattern of movement and stress remains unchanged, the pain burden increases.

Stresses of everyday life such as putting on a coat, shaking hands as a greeting or even holding a cup can also cause considerable pain. It can then become difficult to distinguish tendinopathy from other diseases of the musculoskeletal system.

Diagnosis & disease progression

An untreated tendinopathy is often characterized by a remodeling of its collagen fiber structure. Old collagen fibers are replaced by young collagen fibers that are not yet very tear-resistant, and blood vessels (neovascularization) and pain-conducting nerve fibers proliferate. In some cases, there are also deposits of calcium or fat in the affected tendon.

Imaging diagnostic methods such as ultrasound , magnetic resonance imaging (MRT) or X -rays are therefore recommended for a diagnosis that is to be used as a basis for efficient therapy . Calcium deposits in the tendon attachment ( e.g. heel spur ) can be clearly seen in the X-ray image. The much more complex MRI can then possibly be dispensed with.

Experienced sonography also provides results on which therapy can be based. The course of the untreated disease is not exactly predictable. As a rule, the pain sensation increases, so that the affected persons often prefer immobilisation as pain avoidance therapy.


First and foremost, those affected by tendinopathy suffer from severe pain. These occur either in the form of rest pain or in the form of stress-related pain and can have a very negative effect on the patient’s everyday life. This pain is very unpleasant, especially at night, and can lead to sleep disorders, irritability or even depression.

Many patients also suffer from start-up pain, which makes everyday life even more difficult. Tendinopathy can lead to restricted mobility. The pain usually increases in untreated tendinopathy and does not go away on its own. Even small challenges of everyday life can no longer be carried out easily, so that those affected are dependent on the help of other people in their lives.

In children, the disease can lead to a significantly delayed development of the patient. With the treatment itself, there are no special complications. The symptoms can be limited with the help of medication and therapies. However, long-term use of medication can also damage the stomach. Furthermore, those affected are dependent on physiotherapy to restore movement in the affected region.

When should you go to the doctor?

Loss of function and pain in the area of ​​a tendon can indicate tendinopathy. A doctor’s visit is recommended if non-specific pain occurs that gradually increases and reduces the ability of the affected body part to exercise. Medical advice is required at the latest when the typical pain also occurs during periods of rest. Sudden symptoms, such as those that can occur with tendinopathy as part of arthrosis, must also be medically clarified. If left untreated, the pain burden increases and can cause side effects in the area of ​​the musculoskeletal system.

Possible complications of untreated tendinopathy are postural damage and joint wear. People who put a lot of strain on their muscles, such as regular running or weight lifting, are particularly at risk. Tendinopathies also occur more frequently as part of a muscular imbalance. If you belong to the risk groups, it is best to speak to a specialist. The right contact person is the orthopedist or a sports doctor. Children suffering from tendinopathy should be presented to the pediatrician or an orthopedist. The condition must be treated with medication and physiotherapy, along with the elimination of the causes.

Treatment & Therapy

Since the beginning of the twenty-first century, there has been secure knowledge that tendinopathy is not an inflammatory process. The consequence was derived from this that cortisone treatment is no longer the first choice therapy. Almost exclusively, non-steroidal anti- inflammatory drugs , so-called NSAIDs, are used as painkillers.

Newer therapeutic approaches prefer interdisciplinary approaches and take into account the remodeling of the tissue in the affected tendons. A frequently used treatment method is the focused extracorporeal shock wave therapy , which has been used since the 1980s for the destruction of kidney stones and in a modified form since the 1990s in many areas of orthopedics , among other things .

Shock wave therapy has proven particularly effective in the treatment of heel spurs, calcified shoulders and achillodynia , a pain syndrome of the Achilles tendon. With shock wave therapy, calcium deposits in and on the tendon are loosened. Radial pressure wave therapy has meanwhile become established for the treatment of structures close to the surface in therapy against certain forms of tendinopathy.

In many cases it is helpful to accompany the therapies with individualized eccentric strength training, which should be put together by an experienced physiotherapist . Other accompanying therapies such as kinesio taping and insoles as well as acupuncture applications have also proven to be helpful and effective.


Tendinopathies are not only caused by static and dynamic overloading of the tendons, but also frequently by incorrect loading as a result of unfavorable and unnatural movements when running or when practicing certain sports. Preventive measures are therefore less aimed at protecting the joints by reducing training, but rather at using the correct throwing or running technique. Using optimal movement technique and prior warm-up training are the best preventive measures.


Tendinopathy is mainly caused by improper or excessive strain on the tendons. It is not flammable per se, but can lead to inflammation as a result. Aftercare is designed to avoid renewed stress situations for the respective tendon and also requires further protection of the affected region. It is particularly important to inform the patient about the consequences of tendinopathy.

This can mean an eventual worsening of the condition and the possibility of developing inflammatory tendon disease if stress on the tendon is not interrupted, corrected or reduced. Depending on the cause, the patient may have to make long-term behavioral adjustments, otherwise the tendinopathy will reappear. Special long-term follow-up care for tendinopathy is not required if the patient follows the instructions to protect or put more strain on the body region.

A follow-up examination is possible here to determine the healing of the tendinopathy. It may be necessary to use pain-relieving drug therapy during the aftercare period until it has completely healed. This has to be assessed on a case-by-case basis and by the specialist. If the tendinopathy is treated correctly and consistently, no long-term consequences or permanent damage are to be expected.

You can do that yourself

In the case of tendinopathy, no further self-help measures are usually necessary. Only in the case of acute tendinopathy does the sport practiced have to be paused for a short time. The healing process is promoted by dosed loads such as the so-called “heavy slow resistance training”. Isometric training also brings about rapid pain relief in acute and chronic tendinopathy.

In addition, the cause of the complaints must be clarified. Tendinopathy develops when there is a mismatch between exercise and exercise capacity. Athletes who increase their pace or incorporate additional training sessions risk tendinopathy. As part of treatment, these triggers must be identified and addressed by reducing exercise levels. Eating a healthy diet can also help tendon healing . The body needs sufficient iron , zinc , calciumand vitamins. Micronutrients are also needed in the area of ​​the tendons so that the body can form the healing proteins. This basic therapy can be supported by the local application of glyceryl trinitrate patches and general measures such as rest.

If the symptoms do not go away despite all the measures, the responsible orthopedist must be informed. A change in treatment may then be necessary.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.