What Is Tendonitis?

Tendonitis refers to irritation of a tendon, the strong connective tissue that attaches muscle to bone. Tendons help transfer force from muscles into joints so the body can move, lift, walk, run, jump, grip, throw, reach, and stabilize.

When a tendon is exposed to more stress than it can currently tolerate, it may become irritated. This can happen from repetitive movement, sudden increases in activity, poor movement mechanics, reduced recovery, muscle weakness, or poor load distribution through surrounding joints.

Tendonitis can develop in many areas of the body, including:

• Rotator cuff tendonitis in the shoulder

• Biceps tendonitis in the front of the shoulder

• Tennis elbow or golfer’s elbow around the elbow

• Wrist or forearm tendonitis from gripping or typing

• Patellar tendonitis near the knee

• Achilles tendonitis near the heel

• Hip tendon irritation around the glutes or hip flexors

• Peroneal or posterior tibial tendon irritation around the ankle and foot

Although the word “tendonitis” is commonly used, tendon pain is not always caused by inflammation alone. Many tendon issues are related to overload, reduced tendon capacity, tissue sensitivity, and poor load management. This is why tendon recovery often requires more than rest. The tendon usually needs the right amount of progressive loading to become stronger and more resilient.

Individuals May Experience

• Localized pain near a joint

• Discomfort during movement or activity

• Tenderness when touching the affected tendon

• Stiffness, especially after rest

• Pain that worsens with repeated use

• Reduced strength or function in the affected area

• Pain during sport, exercise, or work tasks

• Morning stiffness or stiffness after inactivity

• Pain that improves with rest but returns with activity

• Weakness with lifting, gripping, running, jumping, or pushing off

• Swelling or thickening around the tendon in some cases

• Reduced confidence using the affected area

• Tightness in surrounding muscles

• Compensation through nearby joints or tissues

Tendon pain should be assessed if symptoms are persistent, worsening, associated with significant swelling, bruising, sudden weakness, a popping sensation, or major loss of function.

What Contributes to Tendonitis?

Several factors may influence tendon irritation, including:

• Repetitive movements during sport or work

• Sudden increases in activity or training load

• Muscle imbalance

• Poor movement mechanics

• Reduced mobility in surrounding joints

• Inadequate recovery between activities

• Poor load management

• Weakness in supporting muscles

• Reduced tendon capacity after inactivity

• Returning to exercise too quickly after time off

• Poor technique during lifting, running, gripping, or jumping

• Prolonged desk work or repetitive computer use

• Overhead activity or throwing demands

• Foot, ankle, hip, shoulder, or spinal mechanics affecting tendon load

• Previous unresolved injuries

• Training or work demands that exceed tissue tolerance

These factors may increase strain on the tendon over time.

Tendons adapt to load, but they need gradual progression. If load increases too quickly, the tendon may not have enough time to adapt. This is common when someone suddenly increases running mileage, starts a new gym routine, returns to sport, changes footwear, increases work demands, or repeats the same movement for long periods.

Tendon irritation may also develop when nearby joints are not moving efficiently. For example, limited ankle mobility can increase strain on the Achilles tendon. Poor hip control can increase stress on the patellar tendon. Upper back stiffness or poor shoulder blade mechanics can overload the rotator cuff tendons. Poor wrist or shoulder mechanics can contribute to elbow tendon pain.

This is why tendonitis is often best understood as a load and movement issue, not only a local tendon problem.

Why Tendonitis Often Comes Back

Tendonitis often becomes recurring when symptoms are reduced but the tendon’s capacity has not fully improved. Rest may calm irritation, but if the tendon is not gradually strengthened, pain may return when activity increases again. For example:

• Achilles tendon pain may settle with rest, then return when running resumes.

• Elbow tendon pain may improve temporarily, then return with gripping or lifting.

• Shoulder tendon pain may calm down, then return with overhead activity.

• Patellar tendon pain may decrease, then return with jumping, stairs, or squats.

This happens because the original load problem remains. The tendon may still be underprepared for the demands placed on it. Surrounding joints may still be restricted. Movement mechanics may still be inefficient. Supporting muscles may still be weak.

A proper care plan should help reduce irritation while also rebuilding the tendon’s ability to tolerate load.

How Manual Therapy May Help

Manual therapy and physiotherapy may help support tendon recovery by addressing the factors that contribute to tendon overload. The goal is not only to reduce pain, but to improve the mechanical environment around the tendon and rebuild tissue capacity over time.

Care may focus on:

• Joint mobility

• Tendon load management

• Progressive strengthening

• Movement retraining

• Activity modification

• Reducing compensation patterns

• Improving surrounding muscle function

• Gradual return to sport, work, or exercise

Osteopathic Manual Therapy

Osteopathic Manual Therapy may evaluate how the affected tendon functions within the broader movement system. Since tendons respond to the forces placed on them, osteopathic care may assess the joints, muscles, fascia, posture, and movement patterns that influence tendon load.

Treatment may include:

• Assessing joint mobility surrounding the tendon

• Addressing fascial tension in nearby tissues

• Improving movement in adjacent joints

• Supporting balanced load distribution during activity

• Identifying compensatory movement patterns

• Reducing protective muscle guarding

• Improving spinal, pelvic, shoulder, hip, ankle, or wrist mechanics when relevant

• Helping reduce unnecessary strain on the irritated tendon

• Supporting better movement through the full kinetic chain

Osteopathic care often focuses on how surrounding structures influence the load placed on the tendon. If the tendon is irritated because nearby joints are stiff or poorly coordinated, improving those areas may help reduce repeated mechanical stress.

For example, shoulder tendonitis may be influenced by rib cage, thoracic spine, or scapular mechanics. Achilles tendonitis may be influenced by ankle, foot, calf, hip, or pelvic mechanics. Elbow tendonitis may be influenced by wrist, shoulder, neck, or upper back movement.

The goal is to reduce unnecessary strain so the tendon has a better environment for recovery.

Physiotherapy

Physiotherapy rehabilitation typically focuses on improving the tendon’s ability to tolerate load. Tendons usually respond best to gradual, progressive strengthening that is matched to the person’s symptoms, stage of recovery, and activity goals.

Treatment may include:

• Progressive loading and strengthening exercises

• Isometric exercises during sensitive stages

• Eccentric and concentric strengthening when appropriate

• Functional strengthening for daily tasks

• Movement retraining during sport, work, or exercise

• Mobility work for surrounding joints

• Activity modification strategies

• Load management education

• Gradual return to sport or activity

• Technique correction for lifting, running, gripping, or overhead movement

• Sport-specific or work-specific progression

• Home exercise programming

These exercises help improve tendon capacity and support recovery over time.

Physiotherapy may also help determine the right balance between rest and loading. Complete rest for too long may reduce tendon capacity, while doing too much too soon may keep the tendon irritated. A structured program helps gradually expose the tendon to load so it can adapt.

Tendonitis in Common Areas

Shoulder Tendonitis

Shoulder tendonitis may involve the rotator cuff or biceps tendon. It may cause pain with lifting, reaching overhead, sleeping on the affected side, or exercise. Rehab may focus on shoulder blade control, rotator cuff strength, upper back mobility, and load management.

Elbow Tendonitis

Elbow tendonitis may appear as pain on the outside or inside of the elbow. It can affect gripping, lifting, typing, tools, racquet sports, golf, or gym training. Rehab may focus on forearm strengthening, wrist mobility, shoulder mechanics, and progressive tendon loading.

Patellar Tendonitis

Patellar tendon irritation may cause pain near the front of the knee, especially with jumping, running, squatting, stairs, or sport. Rehab may focus on quadriceps strength, hip control, landing mechanics, and gradual load progression.

Achilles Tendonitis

Achilles tendon irritation may cause pain near the back of the heel or lower calf, often with running, jumping, walking, or first steps after rest. Rehab may focus on calf strengthening, ankle mobility, foot mechanics, and return-to-running progression.

Wrist and Forearm Tendonitis

Wrist or forearm tendon irritation may develop from typing, mouse use, gripping, lifting, or repetitive hand activity. Rehab may focus on wrist strength, forearm mobility, ergonomics, and load management.

Book an Assessment

If tendon pain during movement, exercise, work, or sport is limiting your ability to stay active, our team can assess contributing factors and guide a personalized treatment plan.

A comprehensive assessment can help identify whether your tendonitis may be influenced by tendon overload, muscle weakness, joint restriction, poor movement mechanics, repetitive strain, training load, or compensation patterns.