Hyaluronic acid
The key molecule behind our treatments
Tendinopathy
Understanding tendinopathy: causes, symptoms, and treatment options
What is tendinopathy?
Tendinopathy refers to pain and dysfunction of a tendon, the tough band of tissue that connects muscle to bone.
Who it affects
Tendinopathy can affect anyone, but it’s especially common among athletes, manual workers, and people with repetitive movement patterns.¹ The most frequently affected sites are the Achilles tendon, rotator cuff (shoulder), patellar tendon (knee), and extensor tendon (forearm).
How it occurs
It often develops when a tendon is overused or overloaded, leading to microscopic damage and degeneration.
What happens in tendinopathy
Healthy tendons are strong, flexible, and built to withstand tension. When overloaded or repeatedly stressed, they can develop small tears and lose their normal structure. Over time, this leads to:1
- Collagen fibre disruption – weakening the tendon’s mechanical strength
- Thickening or swelling – as the body attempts to repair damage
- Chronic pain and stiffness – due to ongoing inflammation and reduced elasticity
The result is a cycle of pain, reduced function, and delayed healing, which can become chronic if left untreated.
Causes and risk factors
Tendinopathy usually results from a mix of mechanical stress and biological vulnerability.
Key contributors include:1
- Repetitive movements or overuse during sport or work
- Sudden increases in training load or changes in activity type
- Age-related changes in tendon elasticity and repair capacity
- Genetic predisposition to the development of tendinopathy
Identifying and modifying these risk factors is essential to support long-term recovery.
Recognising symptoms
Common signs of tendinopathy include:2
- Pain that worsens with movement or activity
- Stiffness, especially after rest or in the morning
- Tenderness at the tendon’s attachment point
- Swelling or thickening around the affected area
- Crackling or grating sensation when moving
Symptoms may appear gradually and can fluctuate with activity levels.
Treatment and management options
The most effective management combines symptom management, mechanical rehabilitation, and support for the tendon environment during recovery. A tailored treatment plan may include:
Conservative approaches
- Physical therapy, particularly eccentric exercise to rebuild tendon strength3
- Shockwave therapy, which is used to assist the body’s natural recovery processes and support the management of chronic tendon symptoms4
Medication and injections
- Non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. ibuprofen) may help short term but are not a long-term solution5
- Corticosteroid injections provide temporary relief but may impair tendon healing6
- Hyaluronic acid injections are an alternative option – clinical studies suggest they can help manage discomfort and support the tendon during recovery by supplementing natural lubrication and providing a supportive environment for the tissue7–9
Our treatment and expertise
When applied around the affected tendon, hyaluronic acid acts primarily as a lubricant and structural support, helping to restore normal function.7–10
- Restores gliding: It reduces friction between the tendon and the surrounding sheath (tenosynovium), allowing for smoother movement9,10
- Mechanical protection: It acts as a viscoelastic buffer, helping to manage mechanical stress at the injury site8,10
Physiological support: By creating a hydrated framework, it helps maintain the optimal physiological environment for natural tissue repair7,10
References
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Xu Y, Murrell GAC. The Basic Science of Tendinopathy. Clinical Orthopaedics and Related Research. 2008;466(7):1528–1538.
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Tendonitis. NHS. Available at: https://www.nhs.uk/conditions/tendonitis/ (accessed December 2025).
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Loiacono C, Palermi S, Massa B, et al. Tendinopathy: Pathophysiology, Therapeutic Options, and Role of Nutraceutics. A Narrative Literature Review. Med Kaunas Lith. 2019;55(8):447.
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Leone L, Raffa S, Vetrano M, et al. Extracorporeal Shock Wave Treatment (ESWT) enhances the in vitro -induced differentiation of human tendon-derived stem/progenitor cells (hTSPCs). Oncotarget. 2016;7(6):6410–6423.
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Davis A, Robson J. The dangers of NSAIDs: look both ways. Br J Gen Pract J R Coll Gen Pract. 2016;66(645):172–173.
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Dean BJF, Lostis E, Oakley T, et al. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum. 2014;43(4):570–576.
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Abate M, Schiavone C, Salini V. The Use of Hyaluronic Acid after Tendon Surgery and in Tendinopathies. BioMed Res Int. 2014;2014:e783632.
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Flores C, Balius R, Álvarez G, et al. Efficacy and Tolerability of Peritendinous Hyaluronic Acid in Patients with Supraspinatus Tendinopathy: a Multicenter, Randomized, Controlled Trial. Sports Med – Open. 2017;3(1):22.
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de Rezende MU, de Campos GC. Viscosupplementation. Rev Bras Ortop Engl Ed. 2012;47(2):160–164.
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Agostini F, de Sire A, Savina A, et al. Effectiveness of Ultrasound-Guided Peritendinous Injection Treatment with Low Molecular Weight Hyaluronic Acid in Patients with Supraspinatus Tendinopathy. Journal of Clinical Medicine. 2025;14(17):6291–6291.
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Ostenil® Tendon IFU. Available at: https://www.trbchemedica.de/mediathek/ostenil-tendon-beipackzettel-ifu-mdr/ (accessed December 2025).