Here’s a term you’ve probably heard a few hundred times before…
If you play regular sport, you’ve probably seen people complain about it. If you work in an office, you may have seen it linked to poor posture or backaches. You may even have encountered it yourself – perhaps without really appreciating it.
So what exactly is tendonitis? What, frankly, are tendons? And how does the ‘itis’ come about?
Here’s a quick primer…
First things first… tendons?
Tendons are the things that connect your muscles to your bones. They’re strong, flexible and made up of thousands of tiny fibres, which are themselves protected by a sheath (synovium). Two key tendons in the knee are the quadriceps tendon (which links your quad muscle to your kneecap) and the patellar tendon (which connects kneecap to shin).
So what’s tendonitis?
Tendonitis is basically a distressed tendon. Often that means inflammation, swelling, redness or pain (the pain typically feels worse on movement). But it can also happen without swelling – for instance, when tiny ‘microtears’ have developed in the tendon. Doctors often use the term ‘tendinopathy’ rather than tendonitis. It covers a wider gamut of tendon problems.
What causes it?
Often the damage happens through overuse: for instance, if you roared flat-out into a new running regime instead of building up gradually. Sometimes it’s an injury; if you twisted your kneecap in football, you might have strained the fibres in your patellar tendon. Sometimes the damage happens through degenerative conditions like rheumatoid arthritis or osteoarthritis.
How do I treat it?
It sounds obvious, but your first move should be to modify or stop any activity that caused the damage. If that ambitious exercise regime is the culprit, ease right back. Or stop completely. In doing this, you’re giving those fibres the time they need to recover. Then deploy the other parts of the famous RICE formula: alongside rest, use ice, compression and elevation. (For more on the benefits of ice and heat for injuries, check out this blog.)
How long should I rest up?
Mild tendonitis usually needs two or three weeks of good rest. With more extensive damage, you’re talking six weeks to three months. But it’s possible you could need much longer than that. Some tendinopathy cases can take up to a year to resolve.
What else helps?
Simple, over-the-counter painkillers like ibuprofen can be helpful, if you can take them. Unlike paracetamol, ibuprofen is an NSAID – a non-steroidal anti-inflammatory drug. That means it can help reduce swelling and inflammation. You can also buy NSAIDS as creams and gels. You might also think about a knee support to aid rest and compression. (For a knee-brace rundown, read this blog.)
Is physio worth a try?
In a word, yes. If your tendonitis is ongoing, restrictive or painful, a physio can help you rebuild strength in surrounding muscles. This gives your tendon a better chance of recovery. We find that patellar and quadriceps tendon problems, in particular, respond very well to physio. For these sorts of injuries you’ll work on a range of ‘extended loading exercises’, like crouching into a squat, to extend and strengthen those key muscles.
What if it doesn’t clear up?
Tendon problems don’t always heal with the passage of time. For one thing, the ‘tendonitis’ could be masking a deeper issue in your knee. That’s something we’d want to explore with imaging scans. In rare cases where you’ve had six months or more of treatment with debilitating symptoms, there are also things we can do in surgery to help, such as debriding (cutting back) degenerate tissue or small portions of bone to prevent rubbing and irritation inside the knee.
The final word…
The good news about tendonitis, however? It very, very rarely sticks around for the long haul. Modifying exercise, resting up, and rebuilding muscle strength are the blocks that build a good recovery in most cases – even if that recovery takes a few months rather than a few weeks. Give your tendons some TLC in the short term and, in most cases, they’ll speed you back to full health.
For further reading
Find out more about knee muscle and tendon injuries in our Conditions pages
Read an interview with Mark, one of the physios who treats our patients with tendon problems