People involved in sports are familiar with the pain that can occur in areas of the body that are frequently subjected to strain. This pain is often due to tendinitis, i.e., inflammation or irritation of a tendon. How is this type of irritation detected, and what can be done about it?

At a glance

  • Tendinitis can develop if a tendon is frequently put under excessive strain.
  • Tendinitis frequently occurs around the shoulders and elbows and, in people who are involved in sports, in the knees and feet.
  • An irritated tendon should be rested for a while.
  • In most cases, rest is followed by physiotherapy.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Tendinitis: older woman in sports clothing sitting on steps in the open air. She is holding her ankle and grimacing with pain.

What is tendinitis?

Tendons are made of connective tissue, and serve to connect muscles and bones with each other. Tendinitis can develop if a tendon is frequently put under excessive strain. Eventually, the tendon may become overstrained and painful. This is often caused by the repetition of the same motion over time, e.g., when playing tennis or volleyball. The tendons in the area of the shoulders and elbows are frequently irritated. In the legs, tendons in the knee and the Achilles tendon at the back of the lower leg are particularly likely to be affected.

An irritated tendon should be rested for a while. After this rest period, the tendon must be allowed to gradually adjust to normal strain again. Specific stretching exercises are used for this purpose.

What are the symptoms of tendinitis?

Pain is the most typical symptom of tendinitis. In many cases, the pain also restricts movements. In addition, the affected area also may become hardened or slightly swollen.

The pain often occurs where the tendon connects with the bone. Tendinitis is especially painful when the tendon is stretched, when the attached muscle is tensed, or when pressure is exerted on the irritated tendon directly. For example, an inflamed or irritated Achilles tendon causes pain when standing on tiptoes. However, pain may also occur at rest.

What causes tendinitis?

Excessive mechanical strain on a tendon can lead to minor injuries and reduced blood flow to the area. This causes adhesions (where scarring causes tissue to stick together) and calcification (a build-up of calcium deposits) to develop in the tendon tissue, leading to irritation.

Tendinitis can develop if a tendon is frequently put under excessive strain.

Excessive mechanical strain usually occurs if the same movements are repeated over time – as in many types of sport. For example, repeatedly swinging the arm to hit a tennis ball or golf ball can gradually lead to irritation of the tendons in the elbow. Regular intensive running can cause excessive strain on the Achilles tendon. Sports that require a lot of jumping, such as volleyball or basketball, often cause tendon pain in the knees. However, other hobbies and work-related activities can also cause tendons to become overstrained – for example, frequent use of a computer mouse.

In rare cases, tendinitis can occur as a side-effect of taking medication, such as certain antibiotics.

What factors contribute to tendinitis?

Risk factors that contribute to the development of tendinitis include:

  • foot deformities
  • ill-fitting shoes
  • diabetes
  • joint diseases
  • autoimmune disorders that cause the immune system to attack tendon tissue 
  • smoking
  • overweight 
Tendinitis becomes more common with age. It particularly affects people involved in sports.

Tendinitis generally becomes more common with age. It particularly affects people involved in sports.

What is the outlook for tendinitis?

As an irritated or inflamed tendon is painful, many people will automatically rest the affected area. In this case, the pain usually resolves after a few weeks. However, the problem may recur if the tendon is subjected to excessive strain again at some point. If the tendon is not rested for a sufficiently long period, the irritated tissue does not have enough time to properly heal. This increases the risk of the tendon becoming partially or completely torn at some point.

How is tendinitis diagnosed?

In addition to examining the affected area, the doctor will ask the patient about his/her occupation and hobbies to determine whether these could explain why the tendon has become overstrained. If the symptoms are typical and if the tendon has been exposed to excessive strain, this is usually enough for the doctor to diagnose tendinitis.

Sometimes, an ultrasound scan is used to identify other indicators of tendinitis, such as small calcium deposits in the tendon. X-rays or magnetic resonance imaging (MRI) scans may be used to rule out other reasons for the symptoms.

How is tendinitis treated?

Initially, the most important treatment is to allow the affected tendon to rest. Wearing a brace or bandages may sometimes be of benefit. The rest period should last between 3 and 6 weeks. After this rest period, the tendon must be allowed to gradually adjust to normal use again.

Other treatments, such as ultrasound therapy, massage, and electrotherapy, are used to promote recovery of the tendon and relieve symptoms. Pain medication may also be used for a limited period.

If the symptoms persist despite treatment with these methods, cortisone injections or surgery may be considered. The surgical procedure involves removing damaged tissue or adhesions.

Further information about treating tendinitis is available on gesundheitsinformation.de.

How does tendinitis affect everyday life?

It can often be difficult to rest an arm or leg while going about one’s daily life. However, strain on the affected tendon should be minimized as far as possible. It can be useful and practical in this context to set priorities. Strenuous activities like cleaning windows, weeding the garden, or carrying heavy bags of groceries, for example, should be avoided. Alternatively, family, friends, or neighbors could perhaps lend a hand.

It is also important to know exactly which movements are to be avoided. A physiotherapist can help with this by explaining which motions will irritate the tendons and which won’t. Occupational therapy may also be beneficial by explaining how daily work-related activities can be done differently to avoid placing too much strain on the tendon.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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