When rest is not enough
The scenario is common: tendon pain develops, it is assumed to be tendinitis, activity is reduced, and sometimes an anti-inflammatory medication is used. Yet several weeks later, the pain is still present or returns as soon as activity resumes.
This difference between what we might expect from a typical acute inflammatory response, which usually improves with rest, and what actually happens in persistent tendon pain deserves a more precise explanation.
Why "tendinitis" is not quite the right word
The suffix "-itis" normally refers to inflammation, as in hepatitis. This can indeed occur during an acute tendon injury, with an inflammatory response following sudden or unusual loading.
When pain becomes established and persists for several weeks, however, the picture is generally different and more complex than simply prolonged inflammation. Collagen fibres can become thinner and disorganised, the tendon matrix changes, and inflammatory mediators may continue to play a role without this representing a classic acute inflammatory process that simply persists unchanged.
This is what we call tendinopathy, and sometimes tendinosis: a condition in which changes in tendon structure become an important part of the picture rather than simply an acute inflammation that has continued over time.
This is also one reason why anti-inflammatory medication alone is not a complete answer to chronic tendinopathy. It may sometimes provide short-term symptom relief, but it does not replace progressive work on the tendon's ability to tolerate load.
What actually happens in the tendon
Several mechanisms contribute to chronic tendinopathy.
When a tendon is repeatedly loaded, it attempts to adapt to the demands placed upon it. In some people, this adaptation process does not proceed normally. Instead of becoming stronger, the tissue accumulates changes because it does not fully recover between periods of loading.
Blood vessels and nerve fibres can also grow into affected areas of the tendon, a phenomenon that appears to contribute to the pain experienced.
Age, insufficient recovery between periods of loading and, in some people, broader metabolic factors can influence the tendon's ability to adapt and recover. As with other persistent pain conditions, factors such as stress and sleep quality can also influence pain sensitivity without being the cause of the tendon problem itself.
How I assess persistent tendon pain
In my practice, when tendon pain persists, I do not look only at the tendon itself. Recent training or activity load, sleep and recovery, the broader inflammatory context and, where relevant, nutritional factors are among the elements I explore alongside examination of the tendon itself.
What actually helps
The standard approach to chronic tendinopathy is based on progressively reloading the tendon, generally through specific exercises adapted to the person's pain tolerance, rather than complete rest. Total rest rarely provides a long-term solution and can delay the tendon's adaptation.
This does not mean continuing to train exactly as before. The aim is to adapt the load placed on the affected tendon, not necessarily to rest the person completely. Finding an alternative activity that helps maintain circulation and general physical conditioning is often part of the recovery period.
When to seek advice
Tendon pain that persists for several weeks despite rest, repeatedly returns when activity resumes, or continues to worsen deserves assessment so that the approach can be adjusted rather than simply waiting for it to disappear on its own.
Sources and further reading
These resources provide further detail on the mechanisms discussed above.
Frequently asked questions
Are tendinitis and tendinopathy the same thing?
In everyday language, the terms are often used interchangeably. Mechanistically, acute tendinitis involves a genuine inflammatory response, whereas chronic tendinopathy is characterised mainly by changes in tendon structure, sometimes accompanied by an inflammatory component that differs from classic acute inflammation.
Do I need to stop sport or physical activity completely?
Not necessarily. The main objective is to reduce and adapt the load on the affected tendon rather than stopping all activity. An alternative form of activity is often recommended during recovery.
Are anti-inflammatory medicines useful?
They may provide short-term pain relief, particularly during a more acute episode, but their effect is often limited once tendinopathy is established. Their use, particularly over longer periods, should be discussed with a doctor or pharmacist.
How long does a tendon take to heal?
This varies considerably depending on the tendon involved, how long the symptoms have been present and the individual's response. Chronic tendinopathy generally takes longer to improve than a recent acute tendon problem.
What is happening in your case?
This article describes general mechanisms. Understanding what is maintaining your tendon pain specifically requires an examination and a proper discussion rather than a generic answer.