Tendons are strong, rope-like tissues containing collagen protein. They connect your muscles to your bones. Tendinopathy, also called tendinosis, refers to the breakdown of collagen in a tendon. This causes burning pain in addition to reduced flexibility and range of motion
While tendinopathy can affect any tendon, it’s more common in the:
- Achilles tendon
- rotator cuff tendons
- patellar tendon
- hamstring tendons
Read on to learn more about tendinopathy, including how it compares to tendonitis and how it’s treated.
Some people use the terms tendinopathy and tendonitis interchangeably. While the two have almost identical symptoms, they’re different conditions.
Tendinopathy is a degeneration of the collagen protein that forms the tendon. Tendonitis, on the other hand, is just inflammation of the tendon.
While you’re likely more familiar with tendonitis, experts believe that tendinopathy is actually more common. It’s just not recognized and diagnosed as often as tendonitis is.
Both tendinopathy and tendonitis are often caused by overuse of or sudden stress on a tendon. Aging and lack of muscle tone can also play a role in the development of tendinopathy.
Doctors previously thought that tendinopathy was an eventual result of tendonitis. But after looking at samples of injured tendons under a microscope, many now believe it’s the other way around — tendonitis is an eventual result of tendinopathy.
This relatively new understanding about the underlying causes and progression of tendinopathy has resulted in changes to common treatment approaches.
Doctors often advise people to take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) for tendinopathy. Remember, they used to think tendon inflammation played a big role in the development of tendinopathy.
Other anti-inflammatories used to treat tendinopathy include:
- diclofenac (Voltaren, Zipsor), a prescription-only NSAID
- injections of corticosteroids, such as triamcinolone acetonide (Volon A)
But some doctors are starting to question this treatment approach, now that they better understand the relationship between inflammation and tendinopathy.
There’s also growing evidence that NSAIDs may actually slow down the recovery process.
For example, a 2013 study found that diclofenac and corticosteroid injections actually slowed down the rate of new tendon cell growth in mice. An older study from 2004 found that ibuprofen had a similar effect on Achilles tendon cells in mice.
While NSAIDs and corticosteroids aren’t being used as much to treat tendinopathy, there are plenty of other options. Most people find that a combination of home treatment and physical therapy works best. But if you have a more severe case, you may need surgery.
Treating tendinopathy usually starts with giving the injured area plenty of rest. But it’s important to still be lightly active to maintain your strength and overall health. If your Achilles tendon is affected, for example, consider opting for low-impact activities, such as swimming.
If you can’t avoid putting repeated stress on the area due to your job requirements, try to shoot for 1 minute of rest for every 15 minutes of work, or 5 minutes of rest for every 20 to 30 minutes.
You can also try the RICE method, which is often very effective for tendon injuries:
- Rest. Try to stay off the affected body part as much as you can.
- Ice. Wrap an ice pack in a light towel and hold it to the affected area for 20 minutes. You can do this up to eight times a day.
- Compress. Wrap the area in an elastic bandage, making sure it’s not too tight.
- Elevate. Keep the affected area raised on a pillow or other device. This can help to reduce any swelling.
A physical therapist can also help you to rebuild strength and stimulate tendon healing through gentle exercises. Your doctor can give you a referral to a qualified physical therapist.
There are several techniques that a physical therapist might use to treat tendinopathy, but two common ones include:
- deep transverse friction massage, a type of connective tissue massage that can help to stimulate cell activity and generate new collagen fibers
- eccentric exercises, which force your muscles to lengthen while they contract, rather than shorten
If you have severe tendinopathy that doesn’t respond to any other treatment, your doctor may recommend tendon repair surgery. They’ll probably recommend you do some physical therapy during the recovery process, which can take up to 12 weeks.
While tendinopathy can be very painful, several things can help to manage the pain. For many people, a combination of home treatment and physical therapy provides relief. But if your symptoms aren’t showing any signs of improvement, it may be time to consider tendon repair surgery.