Tendinitis

Tendinitis and Tendinopathy

What is Tendinitis?

The term "tendinitis" is commonly used to describe any tendon pain. In clinical practice, the term tendinopathy is now preferred, encompassing the various conditions affecting tendons: acute inflammation (tendinitis in the strict sense), chronic degeneration (tendinosis) and synovial sheath involvement (tenosynovitis).

Tendinopathies are common in athletes but also in sedentary individuals, due to repetitive strain or poor posture. They are a regular reason for consulting an osteopath.

Common Locations

• Shoulder — rotator cuff tendinopathy (supraspinatus), subacromial impingement, long head of biceps tendinitis
• Elbow — lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow)
• Wrist and hand — De Quervain's tendinitis, carpal tunnel syndrome (tendon component)
• Knee — patellar tendinopathy (jumper's knee), iliotibial band syndrome (runner's knee)
• Ankle and foot — Achilles tendinopathy, plantar fasciitis

Causes and Contributing Factors

• Mechanical overload — too-rapid increase in training volume, poor technique, repetitive work
• Biomechanical imbalance — joint misalignment, muscular weakness, lack of mobility
• Work posture — prolonged screen position, intensive mouse use
• Inappropriate footwear — a common factor in lower limb tendinopathies
• Systemic factors — certain medications, metabolic disorders

Osteopathic Approach

Osteopathy can contribute to the management of tendinopathies by addressing mechanical and biomechanical factors:

• Restoring joint mobility in regions adjacent to the affected tendon
• Releasing muscular and fascial tension throughout the functional chain
• Addressing identified postural and biomechanical imbalances
• Advice on activity modification, footwear and work posture

The practice also has a shock wave therapy (ESWT) device, with documented efficacy for certain chronic tendinopathies (plantar fasciitis, Achilles tendinopathy, epicondylitis, calcifying shoulder tendinitis).

How Many Sessions?

2 to 4 osteopathic sessions are generally recommended. If shock wave therapy is indicated, a protocol of 3 to 5 sessions is proposed as a complement. Progress is monitored and treatment adapted according to clinical response.

References

• Desjardins-Charbonneau A, Roy JS, Dionne CE, Frémont P, MacDermid JC, Desmeules F. (2015). The efficacy of manual therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 45(5):330-350. PMID 25808530
• Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. (2006). Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ, 333(7575):939. PMID 17012266

Why complete rest usually backfires

The instinct with a painful tendon is to stop entirely. It rarely works. A tendon deprived of load loses its capacity to bear load, so the pain returns as soon as activity resumes — often sooner than before.

What tendons respond to is progressive, controlled loading: enough to stimulate the tissue, not enough to overwhelm it. That principle underlies current tendinopathy management, and it is why treatment combines manual work with a graded return rather than a period of immobilisation.

A useful marker: mild pain during activity that settles within twenty-four hours is generally acceptable and does not indicate damage. Pain that builds during the session, or persists the following day, means the load is still too high.

Shock wave therapy, available at the practice, can be added when pain resists several weeks of well-conducted loading — particularly for the Achilles tendon, the plantar fascia and tennis elbow.