The word tendinopathy describes several common conditions that affect tendons, the tough bands of connective tissue that attach muscle to bone. These conditions include tendinitis and tendinosis. Although they have similarities the two are distinct. The more common is tendinosis, degenerative changes to a tendon, often because of overuse. In contrast, tendinitis consists active inflammation. Health experts used to believe that so-called tendonitis always involved inflammation, but further research shows most cases are degenerative and better described as tendinosis. In fact, only about 3% of cases of tendinopathy are inflammatory in origin.
If you do any type of repetitive movements, work-related or exercise-related, you’re at greater risk of developing a tendinopathy. Why do repeated movements and overuse increase the odds of tendinopathy? Tendons are made up of collagen fibers bundled together in an organized manner that gives them strength. However, if you overuse your tendons or overstretch them, the fibers can develop small areas of trauma called microtrauma. This disrupts the orderly structure of the tendon fibers and may or may not be accompanied by pain and difficulty exercising. Although most people with tendinopathy experience pain or stiffness, some don’t at first. You’ve heard of Achilles tendonitis, most common in runners, but tendonitis can affect other tendons, including those around the elbows, knees, and wrists. For example, if you type or text a lot, don’t be surprised if you develop wrist tendinopathy.
Health Conditions that Increase the Risk of Tendinopathy
If you exercise too often, too vigorously for your fitness level, use poor form, or do repetitive movements, such as running without adequate recovery, your risk of tendinopathy goes up. However, certain medical conditions also put you at higher risk. If you have any of these conditions, it’s important to take steps to lessen your risk of tendon overuse or injury.
In fact, some of the most prevalent chronic health problems enhance the risk of tendinopathy. According to The Journal of Family Practice, hypertension, elevated cholesterol, and diabetes increase susceptibility to developing a tendinopathy. Another risk factor is obesity. Carrying too much weight puts stress on both the tendons and the joint every time you take a step and the stress is magnified when you climb stairs or run.
Medications Linked with Tendinopathy
It’s not just health conditions that heighten the risk of tendon problems. Several classes of medications increase the odds too. For example, people with autoimmune conditions may take glucocorticoids, medications like prednisone, for a lengthy period of time, to reduce inflammation. This can lead to a variety of health problems and even enhance the risk for tendinopathy. However, glucocorticoids aren’t the only drugs that can harm your tendons. A class of antibiotics called fluoroquinolones are also damaging to these strong, fibrous structures. The rate of tendon problems in people who take these medications is between 0.5% and 2%. The symptoms range from tendonitis to complete rupture of the tendon. Sometimes, the tendon issues are severe enough to cause problems with mobility and require surgery.
One of the most common groups of medications that people take in the United States are statin medications for lowering cholesterol and reducing the risk of cardiovascular disease. People who take statins can experience muscle weakness but are also at higher risk of tendinopathy with the Achilles tendon being the most frequently afflicted. In one study, all three medications in the statin family that researchers tested caused tendon deterioration.
Anatomical and Genetic Factors that Increase the Risk of Tendon Problems
There is some genetic susceptibility to tendon problems with certain genetic polymorphisms that increase the risk. If you have anatomic issues, including a significant difference in leg length, it places the tendons in your legs under greater stress and raises the risk of tendon issues. A leg length discrepancy of more than ¾ of an inch is significant, and the longer leg is the side that experiences the most tendon stress. Even less significant leg length discrepancies can cause problems for athletes. So, it’s important to know if you have one.
Lower Your Risk of Tendinopathy
If you take certain medications or have any of the medical conditions discussed, take steps to reduce the stress on your tendons by:
- Circuit training to avoid repetitive movements.
- Warm up for at least 5 minutes before a workout. Include dynamic exercises that raise your body temperature.
- Wear exercise shoes that fit and offer good support.
- Stretch dynamically before a workout and do static stretches after a workout is over. Tight muscles and tendons may be at higher risk of tearing.
- If you experience tightness or an ache around a tendon or joint, stop doing what you’re doing and assess the situation. Don’t exercise through it.
- Use good posture when you stand, walk, and train and good form when you work out.
- Don’t advance your training too fast. Give your muscles and tendons a chance to adapt to the tress you’re placing on them.
- Check with your physician and find out whether you have medical conditions or are taking medications that place you at higher risk.
The Bottom Line
Tendinopathy is common. If you exercise long enough, you’ll likely have one or more bouts of it. However, you may be at higher risk if you have the medical conditions discussed above or if you take certain medications.
References:
- The Journal of Family Medicine. Vol. 69, N0.3. April 2020.
- Sports Med Open. 2017 Dec; 3: 20.
- Published online 2017 May 18. doi: 10.1186/s40798-017-0087-y.
- com. “Aging has distinct and opposite effects on tendon in males and females”
- Knee Surgery Sports Traumatology Arthroscopy 77(6) · August 2015.
- Adv Exp Med Biol. 2016;920:229-38. doi: 10.1007/978-3-319-33943-6_22.
- The University of Rochester Medical Center. “The Best Ways to Treat, Prevent Tendonitis”
- 2017;57(9):541-542.
- US Food and Drug Administration. https://www.fda.gov/Drugs/DrugSafety/ucm511530.htm. Published July 26, 2016. Updated May 10, 2017. Accessed August 22, 2017.
- MedLine Plus. “Tendinitis”
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