Tendons under a magnifying glass. Tendinitis / Tendinosis

The musculoskeletal system consists of bones, joints and muscles. The muscles are attached to the bones by tendons located at both ends of the muscular body. In essence, they are a reticulate-fibrous sheath made up of bundles of collagen, sensory nerve fibers and blood vessels wrapped in thin loose connective tissue. Some are covered by a two-layer connective tissue filled with a fluid that facilitates their slipperiness. Unlike muscles, they do not have the properties: excitability and contractility, but are elastic and stretchy. At the same time, they can withstand heavy loads due to their anatomical structure. Their elasticity is due to the presence of collagen and elastin, and their resistance to stress is due to the direction and distribution of collagen fibers. Tendons are usually located near joints, where the presence of bursa and synovial fluid protects them from friction and damage such as tendinitis or tendinosis.


Tendons can be damaged by excessive stretching caused by sharp muscle contractions or external force loads. This group includes microtrauma in the form of monotonous and monotonous movements. Systemic diseases such as diabetes are a risk factor. And wearing the wrong equipment, inappropriate choice of weights and other mistakes in the training program can develop an acute inflammatory reaction – tendinitis. The tendons in the area of ​​the shoulder, elbow, wrist, knee and heel are most often inflamed, where tendonitis of individual tendons occurs. The clinical picture is characterized by pain, redness, swelling and warmth typical of the inflammatory process. Usually in the acute phase the pain symptoms worsen in the morning and at night. It is characterized by easy fatigue of the affected part with subsequent activation of symptoms, especially in the case where tendinitis becomes chronic. Inflammation and symptoms disappear completely within a few weeks, depending on the degree of damage. Patients are advised to take ice, rest and take anti-inflammatory drugs, followed by physiotherapy and rehabilitation.


Tendinosis most often affects the tendons around the large joints. In essence, it is associated with degenerative changes in the tendons, abnormally changing their structure and leading to functional changes in terms of elasticity and load capacity of the affected area. Tendinosis occurs without an inflammatory reaction, but there is increased sensitivity and pain, especially during physical activity. Although exercise plays a role in the pathology, the following factors are not to be underestimated: gender, age, genes, body structure and lifestyle. Leading in this pathology is the pain symptoms and the change in the structure of the tendon, which makes it more vulnerable. The injuries can be in the middle of the tendon, the musculoskeletal junction or the inertia. The elbow, knee, shoulder and hip joint are often affected. The treatment process is extremely oriented towards physiotherapy and kinesitherapy, even at the first symptoms, due to the lack of an inflammatory process. The treatment can last up to several months, and the adequate gradual load occupies a central place in it.

Tips for the prevention and treatment of tendinitis

  • If possible, avoid monotonous, monotonous movements. They are a major factor in the occurrence of microtrauma.
  • Optimize the training process with an adequate ratio between load and rest.
  • Observe the principle of gradual loading and do not miss the warm-up.
  • Do light stretching without introducing unnecessary stress into the joints. You will achieve this easily if you respect the limit of your body. Stretching helps to increase muscle length, which reduces stress on tendons immediately after muscle contraction.
  • The training process should not bring pain, but a feeling of pleasant movement in the joints and toning the muscles. If your feelings are different, reconsider your technique.
  • Work towards the good alignment of your body. This prevents the occurrence of muscle imbalance.
  • Keep yourself well hydrated. Ensure fresh fruits and vegetables rich in micro and macro nutrients.

How to load properly?

After a short rest to reduce the swelling and inflammation characteristic of the acute phase, a program with a gradual load should be started. It plays a key role in the ability of the affected and more vulnerable tendon to take loads. This would improve the function not only of the tendon itself, but also of the affected joint and would alleviate the long-term pain symptoms. Properly constructed recovery program contains:

  • concentric exercises
  • isometric exercises
  • eccentric exercises
  • plyometric exercises
  • specific training for athletes

For more information and treatment, we at Physio Be Active remain at your disposal.

* This article is informative and cannot replace consultation with a doctor. Before starting treatment, be sure to consult a specialist.

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