Types of Tendonitis: Symptoms, Risk Factors, and Treatment Options

Tendonitis, also spelled as tendinitis, is a common condition characterized by inflammation or irritation of a tendon, the thick fibrous cords that attach muscle to bone. This condition can cause pain, tenderness, and mild swelling at the nearest joint. It can occur in various parts of the body, particularly in areas where tendons are subjected to repeated stress or overuse. Whether you have acute tendonitis or long-term overuse tendinosis, physical therapy can be a valuable treatment option for the condition, no matter where it occurs in the body. Our team at EW Motion Therapy can help create an individualized treatment plan for any type of tendonitis, keeping your goals in mind and helping you return to the activities you love. Whether you choose EW for your physical therapy or not, you can still read this article as we explore the different types of tendonitis, common symptoms, risk factors, treatment options, and the role of physical therapy in managing the condition. 

Common types of tendonitis

Tendonitis and tendinosis can affect any tendon in the body, but some types are more common due to the frequency of use and stress placed on specific tendons. The most common types include:

1. Achilles tendonitis: Achilles tendonitis affects the tendon connecting the calf muscles to the heel bone. It is prevalent among runners and individuals who engage in jumping sports. Symptoms often include pain and stiffness along the Achilles tendon, particularly in the morning or after physical activity. Left untreated, Achilles tendonitis can lead to tendon tears or ruptures, requiring more intensive treatment or surgery.
2. Patellar tendonitis: Also known as jumper’s knee, patellar tendonitis affects the tendon connecting the kneecap (patella) to the shinbone (tibia). This condition is common in athletes involved in sports like basketball and volleyball, where jumping and landing put stress on the knee. Symptoms typically include pain and tenderness around the patellar tendon, especially during activities that involve bending the knee. Chronic patellar tendonitis can lead to degeneration of the tendon fibers, making recovery more challenging.
3. Tennis elbow (lateral epicondylitis): Tennis elbow is a condition that affects the tendons on the outside of the elbow. It is caused by repetitive wrist and arm motions and is common in tennis players, hence the name. However, it can also affect other individuals who perform similar repetitive movements, such as weightlifters, painters, carpenters, and office workers who spend long hours typing. Symptoms include pain and tenderness on the outer part of the elbow, which can radiate down the forearm and worsen with gripping or lifting activities.
4. Golfer’s elbow (medial epicondylitis): Golfer’s elbow affects the tendons inside the elbow. It is caused by repetitive wrist and arm movements, similar to tennis elbow. It can affect golfers and others who engage in repetitive arm activities, such as baseball players and weightlifters. Symptoms include pain and tenderness on the inner side of the elbow, which can radiate down the forearm and worsen with wrist flexion or gripping activities.
5. Rotator cuff tendonitis: Rotator cuff tendonitis involves inflammation of the tendons in the shoulder. It is common in individuals who perform repetitive overhead motions, such as painters, swimmers, and baseball pitchers. Symptoms include pain and weakness in the shoulder, particularly when lifting the arm or reaching overhead. Chronic rotator cuff tendonitis can lead to tendon degeneration and tears, requiring more extensive treatment.
6. De Quervain’s tenosynovitis: This type of tendonitis affects the tendons in the thumb. It is common among new mothers, people who frequently lift children, and individuals who engage in repetitive hand or wrist movements, such as musicians and assembly line workers. Symptoms include pain and swelling near the base of the thumb, which can radiate into the forearm and worsen with gripping or twisting motions.
7. Peroneal tendonitis: Peroneal tendonitis affects the tendons that run along the outer side of the ankle and foot. It is common among runners, hikers, and individuals who engage in activities that involve repetitive ankle motion or sudden changes in direction. Symptoms include pain and swelling along the outer side of the ankle and foot, which can worsen with activity and improve with rest.
8. Bicipital tendonitis: Bicipital tendonitis affects the tendon that connects the biceps muscle to the shoulder and elbow. It is common in individuals who perform repetitive overhead activities, such as weightlifters, swimmers, and baseball players. Symptoms include pain and tenderness in the front of the shoulder, which can radiate down the arm and worsen with lifting or overhead activities.

Common symptoms of tendonitis

The symptoms of tendonitis can vary depending on the location and severity of the condition. Common symptoms include:

1. Pain: Tendonitis typically causes a dull ache, especially when moving the affected limb or joint.
2. Tenderness: The affected area may be tender to touch due to the swelling occurring in the tendon.
3. Swelling: Mild swelling may occur around the affected tendon and inside the joint that it crosses.
4. Stiffness: The affected joint may feel stiff, particularly in the morning or after periods of inactivity.
5. Weakness: Sometimes, the muscle connected to the affected tendon may feel weak, making daily movements more difficult.

Risk factors for developing tendonitis

Several factors can increase the risk of developing tendonitis, including:

1. Age: As people age, their tendons become less flexible and more prone to injury. Tendonitis is more common in individuals over 40.
2. Occupation: Jobs that involve repetitive motions or overhead activities can increase the risk of tendonitis. Examples include carpentry, painting, and assembly line work.
3. Sports: Engaging in sports that require repetitive motions, such as tennis, golf, and basketball, can increase the risk of tendonitis. Improper technique and inadequate warm-up or stretching can also contribute to the condition.
4. Medical conditions: Certain medical conditions, such as rheumatoid arthritis, diabetes, and gout, can increase the risk of developing tendonitis.
5. Previous injuries: A history of tendon injuries can make tendons more susceptible to inflammation and damage.

Treatment options for tendonitis

Treatment for tendonitis typically aims to reduce pain and inflammation and promote healing. Common treatment options include:

1. Rest: Avoiding activities aggravating the condition can help reduce inflammation and promote healing.
2. Ice: Applying ice to the affected area can help reduce pain and swelling, especially in the acute phase.
3. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce pain and inflammation.
4. Injections: In some cases, corticosteroid or platelet-rich plasma (PRP) injections may be used to reduce severe inflammation.
5. Surgery: In rare cases, surgery may be necessary to repair a damaged tendon.

How physical therapy can treat tendonitis

Physical therapy is a key component of the treatment plan for tendonitis, offering a range of interventions tailored to each patient’s specific needs. A comprehensive physical therapy treatment plan not only addresses pain and inflammation but also aims to improve strength, flexibility, and function in the affected area. Here’s an in-depth look at what a physical therapy treatment plan for tendonitis might include:

Initial assessment and diagnosis

The physical therapy journey begins with a thorough initial assessment. The physical therapist will:

• Review medical history: Gather information about the patient's medical history, including any previous injuries, underlying medical conditions, and details about the onset and nature of the current symptoms.
• Physical examination: Conduct a physical examination to assess the affected tendon, evaluate range of motion, strength, and flexibility, and identify contributing factors such as poor posture or improper technique.
• Functional assessment: Evaluate the patient’s ability to perform daily activities and any specific movements exacerbating the symptoms.

Based on the findings, the physical therapist will develop a personalized treatment plan tailored to the patient’s needs and goals.

Components of a physical therapy treatment plan

Pain management

• Modalities: Ice, ultrasound, and electrical stimulation can reduce pain and inflammation. These treatments are typically used in the early stages to manage acute symptoms.
• Manual therapy: Massage and soft tissue mobilization can alleviate pain, reduce muscle tension, and improve blood flow to the affected area.

Exercise therapy

• Stretching exercises: Gentle stretching exercises to improve flexibility in the affected tendon and surrounding muscles. These exercises help alleviate stiffness and promote better range of motion.
  • Example: For Achilles tendonitis, calf stretches can help improve flexibility in the calf muscles, which can reduce stress on the Achilles tendon.
• Strengthening exercises: Progressive resistance exercises to strengthen the muscles around the affected tendon. Stronger muscles can better support the tendon and reduce the risk of re-injury.
  • Example: Exercises like resisted external rotation and scapular stabilization can help strengthen the shoulder muscles in people with rotator cuff tendonitis.
  • Eccentric exercises: Eccentric exercises are a type of strengthening that involves lengthening the muscle while it is under tension. Research has shown that eccentric exercises can be particularly effective for tendon healing.
    • Example: For patellar tendonitis, eccentric squats can help strengthen the patellar tendon and surrounding quadriceps muscles.
• Isometric exercises: Isometric exercises involve contracting a muscle without changing its length. They can help reduce pain and improve tendon stiffness, aiding in the healing process for tendonitis.
  • Example: For wrist tendonitis, try an isometric wrist extension by placing your opposite hand over the back of your affected hand and resisting as you try to lift the wrist upwards, holding for 10-15 seconds.

Functional training

• Activity modification: Education on modifying daily activities and movements to reduce stress on the affected tendon. This may include ergonomic adjustments at work or changes in technique for sports and other activities.
• Movement retraining: Training in proper movement patterns to prevent the recurrence of tendonitis. This includes teaching proper posture, body mechanics, and technique during activities.
  • Example: For tennis elbow, proper wrist and arm positioning during racquet sports can help prevent further strain on the elbow tendons.

Advanced therapeutic techniques

• Neuromuscular re-education: Techniques to improve coordination, balance, and proprioception. This can help the patient regain confidence in their movements and reduce the risk of future injuries.
• Advanced manual therapy techniques: Myofascial release and dry needling can address any underlying muscle imbalances or restrictions that may contribute to tendonitis.

Education and self-management

• Home exercise program: A tailored home exercise program to reinforce the gains made during in-clinic sessions. This program may include stretching, strengthening, and functional exercises to be performed regularly at home.
• Self-care strategies: Education on self-care strategies, including using ice or heat, proper footwear, and techniques for managing symptoms during daily activities.
• Preventive measures: Guidance on preventive measures to avoid re-injury, such as gradual progression of activity levels, adequate warm-up and cool-down routines, and maintaining overall fitness and flexibility.

Return to activity

• Gradual progression: A structured plan for gradually returning to normal activities, work, or sports. The physical therapist will monitor progress and adjust the plan as needed to ensure a safe and effective return to activity.
• Sport-specific training: For athletes, sport-specific training to address the demands of their particular sport. This may include drills, agility training, and exercises to improve power and endurance.

Tendonitis can significantly impact daily activities and overall quality of life. Physical therapy offers a comprehensive, individualized approach to treatment that addresses pain, improves strength and flexibility, and promotes long-term healing. By working closely with a physical therapist, patients can effectively manage tendonitis, prevent future injuries, and confidently return to their favorite activities. If you suspect you have tendonitis, seeking professional medical advice and beginning a tailored physical therapy program can make a substantial difference in your recovery journey. Our physical therapists at EW Motion Therapy consider it a privilege to help our clients reduce pain and return to their favorite activities. To learn more about what your physical therapy program might cost, click below to download our free pricing guide.