7 Common Tendinopathy Symptoms You Should Know

Tendinopathy is a broad term used to describe conditions affecting tendons, the fibrous connective tissues that attach muscles to bones. This condition can affect anyone, from athletes to office workers, and can significantly impact daily activities and quality of life. Understanding the symptoms of tendinopathy is crucial for early detection and proper management of this common musculoskeletal problem.

Tendons play a vital role in our movement and stability, transmitting forces from muscles to bones to create motion. When tendons become damaged or degenerate due to overuse, injury, or aging, tendinopathy develops. This condition most commonly affects the Achilles tendon, rotator cuff, elbow tendons, patellar tendon, and wrist tendons, though it can occur in any tendon in the body.

Recognizing the signs and symptoms early can help prevent further damage and facilitate better outcomes. Below, we explore the most common symptoms associated with tendinopathy that you should be aware of.

1. Localized Pain in the Affected Tendon

Pain is the hallmark symptom of tendinopathy and typically occurs directly over the affected tendon. This pain has distinct characteristics that help identify tendon-related problems:

Pain patterns include:

• Sharp or burning sensation during activity
• Dull aching pain at rest, especially after activity
• Pain that increases with specific movements or activities
• Discomfort when pressing on the affected tendon

The pain often follows a predictable pattern: it may be worse at the beginning of an activity, improve as the tendon “warms up,” and then worsen again after the activity ends. This characteristic pain pattern helps distinguish tendinopathy from other conditions. In early stages, pain might only occur during intense activities, but as the condition progresses, it can become present during everyday tasks like walking, typing, or reaching overhead.

2. Morning Stiffness and Reduced Flexibility

Stiffness is a prominent symptom that many people with tendinopathy experience, particularly during the first few hours after waking up or following periods of inactivity.

This symptom manifests as:

• Difficulty moving the affected joint when first waking up
• A feeling of tightness in the tendon area
• Reduced range of motion compared to the unaffected side
• Gradual improvement in flexibility as you move throughout the day

The morning stiffness typically lasts between 15 to 30 minutes but can persist longer in more severe cases. This occurs because tendons lose fluid during rest periods, and the inflammatory processes associated with tendinopathy can cause tissue changes that affect flexibility. People often describe needing to “work out the stiffness” before they can perform normal activities comfortably.

3. Swelling and Visible Thickening

Inflammation and structural changes in the tendon can lead to visible swelling or thickening around the affected area. This symptom may vary in severity depending on the stage and type of tendinopathy.

Observable changes include:

• Mild to moderate swelling along the tendon
• Thickening of the tendon that can be felt under the skin
• Fullness or puffiness around the affected joint
• Asymmetry when compared to the opposite limb

The swelling may be more noticeable after activity and can be accompanied by warmth in the area. In chronic tendinopathy, the tendon may undergo degenerative changes that result in permanent thickening, making it visibly larger than the corresponding tendon on the unaffected side. This thickening represents the tendon’s attempt to repair itself, though this repair is often disorganized and results in weaker tissue structure.

4. Weakness and Reduced Strength

Tendinopathy frequently causes a noticeable decrease in strength and power in the affected limb or joint. This weakness can significantly impact functional abilities and performance.

Strength-related symptoms include:

• Difficulty performing activities that require force or power
• Reduced grip strength (in cases of elbow or wrist tendinopathy)
• Inability to lift objects that were previously manageable
• Decreased athletic performance in sports-specific movements
• Instability or giving way sensation in the affected joint

The weakness occurs partly due to pain inhibition, where the nervous system reduces muscle activation to protect the damaged tendon from further injury. Additionally, the structural changes in the tendon itself compromise its ability to effectively transmit force from muscle to bone. Over time, people may unconsciously avoid using the affected limb, leading to muscle atrophy and further weakness.

5. Tenderness to Touch

Tenderness upon palpation is a key diagnostic feature of tendinopathy. The affected tendon becomes sensitive to pressure, and touching or pressing on the area elicits pain.

Characteristics of tendon tenderness:

• Pinpoint tenderness directly over the affected tendon
• Pain that increases with direct pressure
• Discomfort when the area is touched, even lightly
• Sensitivity that extends along the length of the tendon

Healthcare providers often use palpation to locate the exact site of tendon pathology and assess the severity of the condition. The degree of tenderness can correlate with the severity of tendinopathy, though this relationship isn’t always linear. Some people with significant tendon degeneration may have surprisingly little tenderness, while others with minor changes experience substantial discomfort. The tenderness is usually most pronounced at the tendon’s insertion point where it attaches to bone or at the musculotendinous junction.

6. Crepitus or Crackling Sensation

Some individuals with tendinopathy experience crepitus, which is a crackling, grinding, or grating sensation or sound that occurs with tendon movement. This symptom is particularly common in certain types of tendinopathy.

Crepitus characteristics:

• Audible creaking or popping sounds during movement
• A sensation of grinding or catching felt under the skin
• More noticeable during specific movements or activities
• May or may not be accompanied by pain

Crepitus occurs when the tendon’s normally smooth surface becomes roughened due to degeneration, inflammation, or changes in the tendon sheath. As the irregular tendon surfaces move against each other or adjacent structures, they produce these characteristic sounds and sensations. While crepitus can be alarming, it doesn’t necessarily indicate severe damage, though it does suggest structural changes within the tendon or its surrounding tissues.

7. Pain That Worsens with Specific Activities

A distinctive feature of tendinopathy is activity-related pain that follows specific patterns based on which tendon is affected. Certain movements or activities consistently provoke symptoms.

Activity-specific pain patterns:

• Achilles tendinopathy: Pain with walking, running, jumping, or climbing stairs
• Rotator cuff tendinopathy: Pain with overhead reaching, lifting, or throwing
• Tennis elbow (lateral epicondylitis): Pain with gripping, twisting motions, or lifting objects
• Patellar tendinopathy: Pain with jumping, squatting, or kneeling
• De Quervain’s tendinopathy: Pain with thumb movements, gripping, or wrist deviation

Understanding these activity-specific pain patterns helps identify which tendon is affected and guides activity modification strategies. The pain typically increases proportionally with the intensity and duration of the aggravating activity. In advanced cases, even minimal activities can trigger symptoms, significantly limiting daily function and quality of life.

Main Causes of Tendinopathy

Understanding what causes tendinopathy can help with prevention and management. The following are the primary factors that contribute to tendon problems:

Overuse and Repetitive Strain

Repetitive movements, especially those performed with high frequency or intensity, are the most common cause of tendinopathy. Athletes, manual laborers, and people who perform repetitive tasks at work are particularly susceptible. The cumulative stress on tendons exceeds their capacity to repair, leading to degeneration.

Sudden Increase in Activity Level

Rapidly increasing the intensity, duration, or frequency of physical activity without adequate adaptation time can overwhelm tendons. This “too much, too soon” approach is common in weekend warriors or people starting new exercise programs without proper progression.

Aging and Degeneration

As we age, tendons naturally lose elasticity, become less vascular, and have reduced healing capacity. The cellular composition changes, and the collagen structure becomes less organized, making tendons more vulnerable to injury and degeneration.

Biomechanical Abnormalities

Poor posture, muscle imbalances, improper technique, or anatomical variations can place abnormal stress on tendons. For example, flat feet can increase strain on the Achilles tendon, while muscle weakness can overload surrounding tendons.

Previous Injury

A history of tendon injury increases the risk of developing tendinopathy. Scar tissue from previous injuries may not have the same structural integrity as healthy tendon tissue, making it more susceptible to re-injury.

Certain Medical Conditions

Some systemic conditions increase tendinopathy risk, including diabetes, rheumatoid arthritis, gout, thyroid disorders, and obesity. These conditions can affect tendon structure, healing capacity, or place additional mechanical stress on tendons.

Medications

Certain medications, particularly fluoroquinolone antibiotics and corticosteroids, have been associated with increased risk of tendon problems. If you’re concerned about medication effects, consult with your healthcare provider.

Prevention Strategies

While not all cases of tendinopathy can be prevented, the following strategies can significantly reduce your risk:

Gradual Progression

When starting a new activity or increasing training intensity, follow the “10% rule” – don’t increase your activity level by more than 10% per week. This allows tendons adequate time to adapt to increasing loads.

Proper Warm-Up and Cool-Down

Always begin exercise sessions with a thorough warm-up to increase blood flow to tendons and muscles. Similarly, cool down properly to facilitate recovery. Include both general cardiovascular warm-up and specific movements related to your planned activity.

Strength Training

Regular strength training helps tendons adapt to load and builds capacity to handle stress. Focus on exercises that target the specific tendons at risk for your activities, using progressive loading principles.

Maintain Flexibility

Regular stretching and mobility work helps maintain optimal tendon length and joint range of motion, reducing abnormal stress on tendons during movement. Include both static and dynamic stretching in your routine.

Use Proper Technique

Whether at work, in sports, or during daily activities, using correct form and technique reduces unnecessary strain on tendons. Consider working with a coach, trainer, or physical therapist to optimize your movement patterns.

Cross-Training

Varying your activities prevents overloading the same tendons repeatedly. Incorporate different types of exercise that use different movement patterns and stress different body parts.

Adequate Rest and Recovery

Include rest days in your training schedule and ensure adequate sleep. Tendons need recovery time to repair and adapt. Listen to your body and reduce activity when experiencing early warning signs of overuse.

Maintain Healthy Body Weight

Excess body weight increases mechanical stress on weight-bearing tendons, particularly in the lower extremities. Maintaining a healthy weight reduces this burden.

Stay Hydrated

Proper hydration supports tendon health and function. Dehydration can affect tissue properties and potentially increase injury risk.

Frequently Asked Questions

How long does tendinopathy take to heal?

Recovery time varies significantly depending on severity and location, typically ranging from several weeks to several months. Chronic tendinopathy may take 3-6 months or longer with appropriate management. Early intervention generally leads to faster recovery.

Can tendinopathy heal on its own?

Mild cases may improve with rest and activity modification, but most cases benefit from active management including specific exercises and gradual return to activity. Without proper management, tendinopathy often becomes chronic or worsens over time.

Is tendinopathy the same as tendinitis?

Tendinopathy is a broader term encompassing all tendon pathology, while tendinitis specifically refers to acute tendon inflammation. Most chronic tendon conditions involve degeneration rather than inflammation, making “tendinopathy” the more accurate term.

When should I see a doctor for tendon pain?

Seek medical attention if pain persists beyond a few days despite rest, significantly limits your activities, is accompanied by severe swelling or redness, occurs after a sudden injury, or progressively worsens. Early professional evaluation can prevent chronic problems.

Can I exercise with tendinopathy?

Complete rest is rarely recommended. Modified activity and specific loading exercises are often beneficial for tendon healing. The key is finding the right balance – reducing aggravating activities while maintaining appropriate loading to stimulate tendon adaptation. Consult a healthcare professional for personalized guidance.

Does tendinopathy show up on X-rays?

X-rays typically don’t show tendon damage directly, but may reveal calcifications or bone changes associated with chronic tendinopathy. Ultrasound and MRI are better imaging modalities for visualizing tendon pathology.

Are certain people more prone to tendinopathy?

Yes, athletes, manual laborers, people over 40, those with previous tendon injuries, individuals with certain medical conditions (diabetes, rheumatoid arthritis), and people with biomechanical abnormalities have higher risk.

Can tendinopathy become permanent?

Without proper management, tendinopathy can become chronic and result in permanent structural changes to the tendon. However, even chronic cases can significantly improve with appropriate intervention, though complete restoration to pre-injury state may not always be possible.

What’s the difference between tendinopathy and a tendon tear?

Tendinopathy refers to tendon degeneration and pain, while a tendon tear is a structural rupture of tendon fibers. Tears can be partial or complete and typically occur suddenly with severe pain, while tendinopathy develops gradually. However, chronic tendinopathy increases the risk of tendon tears.

References:

• National Center for Biotechnology Information – Tendinopathy Overview
• Mayo Clinic – Tendinitis
• Physiopedia – Tendinopathy
• Johns Hopkins Medicine – Tendinitis
• NHS – Tendonitis