Tendinopathy

What tendinopathy is

Tendons pass the pull of your muscles to your bones. When a tendon is asked to do more than it can cope with, it can become painful, stiff and weaker. You may hear it called tendonitis, tendinitis or tendinosis. Tendinopathy is the general term.

When the tendon's covering, or sheath, is affected, it is called tenosynovitis. De Quervain's is one example.

Tendinopathy often starts when the load on a tendon goes up faster than the tendon can adapt. Common causes include:

It can affect anyone, but it is most common in middle age. Tennis elbow, for example, mostly affects people aged 35 to 54, and men and women equally.

Types of tendinopathy

Tendinopathy is usually named after the tendon or place it affects.

Tennis elbow

Pain on the outside of the elbow and forearm, worse when gripping, lifting or twisting. Typing and mouse work are common causes, not just tennis. It affects 1 to 3 in 100 people.

Golfer's elbow

Pain on the inside of the elbow, from the tendons that bend the wrist and fingers. It is treated in a similar way to tennis elbow.

Rotator cuff tendinopathy

Shoulder pain, often when lifting your arm out to the side or overhead, or lying on that side. Sometimes called shoulder impingement. It causes up to 70% of shoulder pain.

De Quervain's tenosynovitis

Pain and swelling on the thumb side of the wrist, worse when pinching or gripping. It is more common in women, and in parents of young babies.

Achilles tendinopathy

Pain and stiffness at the back of the heel or lower calf, often worst first thing in the morning. It can be in the middle of the tendon or where it joins the heel bone.

Other tendons

Including the wrist and forearm tendons, the patellar tendon below the kneecap, and the tendons on the outside of the hip.

Symptoms and how it progresses

Symptoms include:

Pain that is worse when you move or use the tendon
Stiffness, especially in the morning
Tenderness when you press on it
Weakness, such as a poor grip
Swelling, sometimes warm or red
A grating or crackling feeling when you move

Tendons heal slowly because they have a limited blood supply. Recovery times vary a lot by tendon:

2 to 3 weeks

Mild strain

Mild tendon injuries often settle within 2 to 3 weeks with self-care and gradual return to activity.
6 to 12 weeks

De Quervain's

Usually settles in 6 to 12 weeks with rest from painful tasks, a splint and exercises.
3 to 6 months

Rotator cuff

Exercise takes at least 12 weeks, with gains up to 24 weeks. You may notice little change in the first 6 weeks.
Up to a year or more

Elbow and Achilles

Tennis elbow and Achilles tendinopathy often take several months. Nearly 9 in 10 people with tennis elbow are much better or recovered within a year.

Timings are typical ranges, not exact rules. Keep going with your exercises even when progress feels slow.

When to get urgent help

Call 999 if you have

sudden arm, shoulder or jaw pain with chest pain, breathlessness or sweating
sudden weakness or numbness on one side of your body, or a drooping face or slurred speech
a limb that is suddenly cold, pale or blue and very painful

Call NHS 111 or go to an urgent treatment centre if

you heard a snap or pop and felt sudden pain, for example at the back of your ankle. This could be a torn tendon
you can't stand on tiptoe or push off when walking after an injury
you suddenly can't lift or move your arm
a joint is very swollen, hot and red, or you have a high temperature
a limb has changed shape after a fall

See your GP or physiotherapist if

pain hasn't improved after 2 weeks of self-care
symptoms have lasted several weeks or are getting worse
pain stops you working or sleeping
you have tendon pain while taking an antibiotic or new medicine

Diagnosis and referral

A GP or physiotherapist can usually diagnose tendinopathy by asking about your symptoms and examining you. They will press on the tendon and test it against resistance.

Scans are not usually needed. An ultrasound or MRI scan may be used if a tear is suspected, if the diagnosis is unclear, or before surgery. An X-ray can show calcium deposits in the shoulder.

Self-referral to physiotherapy

In many areas you can refer yourself to NHS musculoskeletal (MSK) physiotherapy without seeing a GP. Many GP surgeries also have a first contact physiotherapist you can book through reception. Physiotherapy is the main treatment for most tendinopathy.

If you aren't improving after a good trial of physiotherapy, you can be referred to an MSK specialist, a sports medicine doctor, or an orthopaedic surgeon. NHS physiotherapy is free, but waiting lists can be long.

Treatments and medicines

The main treatment is exercise that gradually loads the tendon, so it gets stronger. Complete rest for long periods weakens tendons, so stay as active as pain allows.

Relative rest and ice

At home, first 2 to 3 days

Ease off what makes it worse, without stopping all movement. A cold pack wrapped in a towel for up to 20 minutes every 2 to 3 hours can help a flare.

Painkillers and gels

From a pharmacy or supermarket

Paracetamol, or anti-inflammatory painkillers such as ibuprofen, for short periods. Anti-inflammatory gels on the skin are often preferred because they have fewer side effects. Your GP can prescribe stronger anti-inflammatories if needed.

Physiotherapy and loading exercises

NHS self-referral, GP referral or private

A programme of strengthening exercises built up slowly over weeks and months. Some pain during exercise is normal if it settles soon after. Expect at least 12 weeks for shoulder and Achilles programmes.

Supports, splints and insoles

Physiotherapist, podiatrist or pharmacy

A forearm strap for tennis elbow, a thumb splint for de Quervain's, or heel raises and insoles for Achilles pain. They ease symptoms while the tendon recovers.

Steroid injections

GP, physiotherapist or specialist

Helpful for some tendons. A steroid injection relieves de Quervain's pain in about 7 in 10 people. They may be used for very painful shoulders, but repeated shoulder injections can harm the tendon. They are not recommended for tennis elbow: pain can be worse at 6 months than with no injection.

Shockwave therapy

Specialist or private clinic

Sound waves passed through the skin over a course of sessions. NICE says the evidence for Achilles tendinopathy is limited, so it should only be used with special arrangements. UK elbow specialists advise against it for tennis elbow. It is more widely used for calcium deposits in the shoulder.

Be cautious about costly treatments

Platelet-rich plasma (PRP) injections, shockwave and other private treatments are widely advertised. For some tendons, good research has found them no better than a placebo. Ask your physiotherapist or doctor what the evidence shows for your tendon before you pay.

Surgery

Most people with tendinopathy get better without surgery. It is only considered when other treatments have failed for many months, or for a torn tendon.

De Quervain's release

Small operation under local anaesthetic

The surgeon widens the tunnel the thumb tendons run through. Pain relief is usually quick. The scar can be tender for a few weeks.
Tennis elbow surgery

Only after 6 to 12 months of other treatment

Damaged tissue is removed or released. UK specialists advise caution, because research has not shown a clear benefit over placebo surgery.
Shoulder surgery

Only if physiotherapy and other treatments haven't helped

Subacromial decompression trims bone and tissue at the top of the shoulder. UK research suggests it may have limited benefit. Torn rotator cuff tendons may be repaired. Physiotherapy afterwards is essential.
Achilles tendon rupture

About 9 weeks in a boot, with or without surgery

A torn Achilles is treated in a special boot, sometimes with surgery. Office work may be possible after 2 weeks, though 8 weeks is often advised. Physical jobs usually need 12 to 16 weeks. Sport takes 4 to 12 months.

Driving: after an Achilles rupture, don't drive a manual car for at least 9 weeks. Check with your clinician and insurer.

Self-help and living well

Looking after the tendon

Keep moving. Avoid long periods of complete rest
Do your exercises little and often, and build up slowly
Some discomfort is OK if it settles within a day
After a flare, cut back a little rather than stopping
Wear supportive shoes for Achilles pain

At work and home

Take regular short breaks from repeated tasks
Use your whole hand and a lighter grip
Keep things you use within easy reach to avoid overhead reaching
Increase sport or training gradually

Tips for getting the best treatment

Make the most of your care

Tell your clinician about your job, sport and any recent changes in activity
Mention any medicines you take, especially antibiotics or statins
Ask for a written or video exercise plan you can follow at home
Give exercises at least 12 weeks before judging them
Ask what the evidence says before paying for injections or shockwave
If you are not improving, ask to be reviewed or referred

Tendinopathy and work

What your employer must do

Employers must assess and reduce the risk of upper limb disorders, under the Health and Safety at Work Act and the Management of Health and Safety at Work Regulations. The HSE says employers should encourage staff to report symptoms early. If you use a screen daily for an hour or more at a time, your employer must also carry out a DSE workstation assessment, and look again when you report pain. This applies to home workers too.

Your rights under the Equality Act

Tendinopathy can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland). This applies if it has more than a minor effect on your daily life and has lasted, or is likely to last, at least 12 months. If it does, your employer must make reasonable adjustments, such as:

Changing or rotating tasks
Avoiding heavy lifting or overhead work for a while
More frequent breaks
A phased return after time off
Time off for physiotherapy
Specialist equipment

Equipment that can help

Access to Work is a government grant that can pay for specialist equipment and assistive software at work. For advice on your rights, contact Acas or Citizens Advice.

Benefits

If you are too unwell to work, you may get Statutory Sick Pay from your employer for up to 28 weeks.

Inflammation of the tendons of the hand or forearm, or their sheaths, caused by manual work or repeated hand and wrist movements, is a prescribed disease for Industrial Injuries Disablement Benefit. You must have been employed, not self-employed. Other tendons, such as the shoulder or Achilles, are not usually covered.

If your condition makes daily tasks hard over the long term, you may be able to get Personal Independence Payment (PIP), or Adult Disability Payment in Scotland. Turn2us and Citizens Advice can help you check.

How The Beyond Pain Foundation can help

If NHS waits are too long, or the help you need isn't available to you on the NHS, we may be able to fund:

A course of private physiotherapy with a loading exercise programme
A private consultation with a musculoskeletal or sports medicine specialist
An ultrasound scan, where your clinician recommends one
Splints, supports or insoles recommended by your physiotherapist or podiatrist
Workplace or home equipment, such as a vertical mouse, voice software or a sit-stand desk

We fund treatment and equipment, not everyday living costs. We are unlikely to fund treatments that good evidence shows don't work for your tendon. Prices vary, so always get a written quote to include with your application.

Apply for funding Check the requirements

Support and sources

Versus Arthritis

Information and helpline

Helpline 0800 5200 520, Monday to Friday, 9am to 6pm. Information on shoulder, elbow and hand conditions.

versusarthritis.org

Chartered Society of Physiotherapy

Professional body for physiotherapists

Exercise videos for elbow and shoulder pain, and help finding a chartered physiotherapist.

csp.org.uk

NHS

Health information

Symptoms, self-care and when to get help with tendonitis.

nhs.uk/conditions/tendonitis

Sources for this guide

Last reviewed: October 2026.