What is tendinopathy?

Tendinopathy is a painful condition that most often affects people who are active and play sports. It is known as an overuse injury, or a repetitive strain injury. Common places where tendinopathy can occur are in the knees, elbows, shoulders, and ankles. Elbow tendinopathies are sometimes called 'tennis elbow' or 'golfer's elbow'. Achilles tendinopathy occurs in the Achilles tendon, the thick tendon that runs down the back of the ankle.

There are 2 main types of tendinopathies:

• Tendinitis — inflammation of the tendon.
• Tendinosis — degeneration (breakdown) of the tendon.

What are the symptoms of tendinopathy?

Tendinopathy can cause pain, swelling weakness and difficulty moving the affected area.

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What causes tendinopathy?

Tendinopathy is caused by doing the same movements over again, or from sudden movements that put too much stress on the tendon. It happens when the tissue that connects muscles to bones, called tendons, gets injured or strained.

When should I see my doctor?

See a doctor if you have:

• persistent or worsening pain
• swelling of the affected area
• difficulty moving a joint
• pain that interferes with your daily activities, work or sports
• change in the colour of the skin in the affected area (for example, if the skin turns blue or white)
• redness and heat in the area, or you develop fever-like symptoms

Your doctor can diagnose the condition, provide appropriate treatment and give you advice on how to manage and prevent further problems. Your doctor may also refer you to a physiotherapist or occupational therapist.

Don't ignore the symptoms of tendinopathy, as early treatment can lead to faster recovery and better outcomes.

How is tendinopathy diagnosed?

Your doctor will diagnose tendinopathy based on clinical symptoms — they will examine you and ask questions about your pain. In some situations, they will refer you for other tests or imaging (x-ray or ultrasound).

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How is tendinopathy treated?

Like all soft tissue injuries, treat tendinopathy according to the RICER protocol for the first 2 to 3 days:

• Rest
• Ice
• Compression
• Elevation
• Referral

This helps reduce the bleeding and damage within the joint.

There are also things you should avoid — known as the No HARM protocol:

• no Heat
• no Alcohol
• no Running or physical activity
• no Massage

After the initial period, your doctor or physiotherapist may recommend pain relief, stretching exercises and changes in sports techniques and footwear to reduce stress on the tendon. Less commonly, you may need to treat tendinopathy with injections or surgery.

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Can tendinopathy be prevented?

Tendinopathy happens if you overuse a joint, without giving the tendon time to heal and rest. Avoid repetitive strain injury on joints can help prevent tendinopathy. Even tiny movements, such as clicking a mouse, can cause tendinopathy, when done repeatedly.

It's also important to listen to your body and rest if you feel any pain or discomfort. If you play sport, or use repeated movements at work or for recreation, pay attention to pain or swelling in your joints. You can also ask your doctor, physiotherapist or sports coach how to prevent injury.

Eating a healthy diet rich in nutrients like vitamin C, vitamin B6, vitamin E and some minerals can also help keep tendons strong. By practising good habits and being mindful of your body's signals, you can reduce the risk of developing tendinopathy.

Complications of tendinopathy

It's important to rest and follow a doctor's advice if you have tendinopathy, as ignoring it can make it worse, risk further damage and delay your recovery.

Resources and support

• Visit WorkSafe Victoria to watch videos explaining manual handling in the workplace and how to prevent injury.
• Read more on managing elbow tendinopathy (tennis and golfer's elbow) on the NSW Health and Agency for Clinical Innovation fact sheet.
• Visit Musculoskeletal Australia to learn about the role of a hand therapist in hand tendon injures.
• Learn about Achilles tendon injuries on the Sports Medicine Australia website.