What a tendon problem actually is
A tendon transmits force from muscle to bone. It adapts to the load it is given — slowly, and more slowly than muscle does. Most tendon problems arise when load increases faster than the tendon’s capacity to adapt: a new job, a new sport, a return after time off, a change in footwear or technique.
In the first weeks there is genuine inflammation, and “tendonitis” is a fair description. After that, what is found in the tissue is different: disorganised collagen, changes in the ground substance, new blood vessel and nerve growth, and not much inflammation at all. The word for that is tendinopathy, and it explains why treatments aimed at inflammation stop working after the early phase.
The ones seen most often
- Lateral and medial epicondylitis — tennis and golfer’s elbow. Point tenderness at the elbow, pain with gripping.
- Rotator cuff tendinopathy — shoulder pain reaching overhead, worse lying on it.
- Patellar tendinopathy — pain just below the kneecap, worse with jumping, squatting and stairs.
- Achilles tendinopathy — pain and morning stiffness at the back of the heel or a few centimetres above it.
- Gluteal tendinopathy — pain over the outer hip, painful to lie on, commonly mislabelled bursitis.
How it is assessed
Palpation to localise the exact point, which is usually precise and reproducible in a tendon problem. Resisted testing of the muscle that tendon serves. A history of what changed — training, work, activity, footwear — because the change is usually the cause and it will still be there after treatment unless it is addressed. Imaging where it will alter the plan.
Treatment
Progressive loading is the core of it, and it is a programme rather than an exercise sheet: specific to the tendon, started at a level the tendon tolerates, and increased as it adapts. This is what remodels the tissue. It requires months and it requires review.
Load management alongside — modifying, not eliminating, the activity that provoked it.
PRP in selected cases, where the aim is to support the tendon’s repair environment. Used where the evidence for that particular tendon supports it, not as a default.
Injections used judiciously, and steroid used sparingly in tendons for the reasons above.
A physician trained in Physical Medicine & Rehabilitation is exactly the right person for this problem, because the treatment is a rehabilitation programme with medical adjuncts, and not the other way around.