What Is Tendon Degeneration? Understanding Chronic Tendon Damage

When we think about tendon injuries, we often think of sudden tears or acute inflammation. But there’s another category of tendon problems that’s equally important: tendon degeneration, also known as tendinosis.

Unlike acute tendonitis, tendon degeneration develops slowly over time, often going unnoticed until it becomes a significant problem. Understanding this condition is crucial for anyone who wants to maintain an active lifestyle and protect their tendons from long-term damage.

What Exactly Is Tendon Degeneration?

Tendon degeneration refers to the chronic, degenerative changes that occur in a tendon due to repeated microtrauma and inadequate healing. It’s a process where the tendon’s structure gradually breaks down, becoming weaker and less able to handle stress.

The Science Behind Tendon Degeneration

Healthy tendons are composed of:

  • Collagen fibers: Strong, flexible protein fibers that provide tensile strength
  • Proteoglycans: Molecules that help retain water and provide cushioning
  • Tenocytes: Specialized cells that produce collagen and maintain tendon tissue
  • Blood vessels: Supply nutrients and enable healing

When a tendon is subjected to repeated stress, small tears occur in the collagen fibers. In a healthy tendon, these microtears heal through a process called remodeling. However, when the rate of damage exceeds the rate of healing, degeneration sets in.

What Happens During Tendon Degeneration?

  1. Microtears accumulate from repetitive stress
  2. Collagen organization breaks down — fibers become disorganized and less efficient
  3. Tenocyte function impaired — the cells can’t produce collagen effectively
  4. Increased ground substance — the tendon becomes thicker and more gelatinous
  5. Reduced blood flow — healing nutrients have difficulty reaching the tissue
  6. Structural weakness — the tendon becomes prone to tears and ruptures

Common Types of Tendon Degeneration

Tendon degeneration can affect any tendon in the body, but some locations are more common:

Frequently Affected Tendons

  1. Posterior Tibial Tendon — Inner ankle, common in runners and those with flat feet
  2. Achilles Tendon — Back of the ankle, prevalent in athletes
  3. Patellar Tendon — Below the kneecap, affects jumpers
  4. Rotator Cuff Tendons — Shoulder, common in overhead athletes and older adults
  5. Extensor Tendons — Top of the foot, affects runners
  6. Flexor Tendons — Palm side of hands, common in climbers

Causes of Tendon Degeneration

Understanding the causes helps in both prevention and treatment. Tendon degeneration typically results from a combination of factors rather than a single cause.

Primary Causes

1. Chronic Overuse

The most common cause. Repetitive activities that stress a tendon beyond its capacity to recover:

  • High-volume training in athletes
  • Repetitive work tasks (construction, manufacturing, typing)
  • Prolonged standing or walking
  • Sports requiring repeated movements (tennis, running, basketball)

Tendons naturally change with age:

  • Decreased collagen production
  • Reduced blood supply
  • Loss of elasticity
  • Accumulated wear and tear over years

3. Biomechanical Factors

Individual anatomy can predispose someone to tendon problems:

  • Flat feet or high arches
  • Leg length discrepancies
  • Muscle imbalances
  • Poor posture or gait abnormalities

Contributing Factors

  1. Inadequate Recovery

    • Not allowing enough rest between activities
    • Training through pain
    • Returning to activity too quickly after injury

  2. Poor Training Practices

    • Sudden increases in intensity or volume
    • Inadequate warm-up
    • Training on inappropriate surfaces

  3. Environmental Factors

    • Cold weather (tendons become stiffer)
    • Inappropriate footwear
    • Poor equipment (rackets, shoes, etc.)

  4. Systemic Factors

    • Diabetes
    • Rheumatoid arthritis
    • Obesity
    • Smoking (impairs blood flow)

Symptoms of Tendon Degeneration

Recognizing the symptoms of tendon degeneration is important for seeking early treatment. The symptoms often develop gradually and can be mistaken for simple soreness.

Warning Signs

  1. Chronic Pain

    • Persistent ache in or around a tendon
    • Pain that worsens with activity and improves with rest
    • Pain that doesn’t fully resolve with rest

  2. Morning Stiffness

    • Significant stiffness after periods of inactivity
    • Pain with first movements that improves with warming up

  3. Reduced Performance

    • Decreased strength in the affected area
    • Reduced endurance
    • Feeling of “giving way” or instability

  4. Physical Changes

    • Thickening of the tendon
    • Nodular or knotted feeling in the tendon
    • Mild swelling
    • Reduced range of motion

  5. Symptoms That Differ From Acute Tendonitis

    • No significant redness or heat
    • Pain has been present for more than 6-12 weeks
    • Symptoms have a gradual onset rather than sudden

Diagnosing Tendon Degeneration

Proper diagnosis is essential because treatment differs from acute tendonitis.

Clinical Evaluation

A healthcare provider will:

  • Take a detailed history of symptoms and activity
  • Perform a physical examination
  • Assess strength, flexibility, and tenderness
  • Evaluate biomechanics

Imaging Studies

  • MRI: Gold standard for visualizing tendon degeneration, tears, and abnormalities
  • Ultrasound: Can show real-time tendon structure, thickening, and tears
  • X-rays: Primarily to rule out other conditions (fractures, arthritis)

Key Findings in Tendon Degeneration

  • Thickened tendon
  • Abnormal signal within the tendon
  • Areas of degeneration or tearing
  • No significant inflammation (which would suggest tendonitis)

Treatment Options for Tendon Degeneration

Treatment for tendon degeneration focuses on stimulating healing, reducing pain, and addressing underlying causes. This differs from tendonitis treatment, which focuses more on reducing inflammation.

Conservative Treatments

1. Activity Modification

  • Reduce activities that stress the tendon
  • Cross-train with low-impact activities
  • Avoid aggravating movements
  • Allow adequate recovery time

2. Physical Therapy (Most Important)

Targeted exercises are the cornerstone of treatment:

  • Eccentric exercises: Slow, controlled lengthening exercises proven to promote tendon healing
  • Isometric exercises: Static contractions to maintain strength during recovery
  • Progressive strengthening: Gradual increase in resistance
  • Stretching: Maintaining flexibility
  • Proprioception training: Improving balance and joint awareness

3. Orthotics and Support

  • Custom or over-the-counter orthotics
  • Supportive footwear
  • Bracing or taping for some tendons

4. Modalities

  • Shockwave therapy: Stimulates healing through sound waves
  • Platelet-Rich Plasma (PRP): Injections using concentrated platelets
  • Prolotherapy: Injections to stimulate healing
  • Physical modalities: Ice, heat, ultrasound

5. Medications

  • Pain relievers as needed
  • Topical treatments
  • Note: Corticosteroid injections are generally avoided in degeneration as they can weaken tissue

Surgical Treatment

Surgery may be considered if conservative treatment fails (typically after 3-6 months):

  • Debridement: Removing degenerated tissue
  • Repair: Suturing torn areas
  • Transfer: Using another tendon to restore function
  • Regeneration procedures: Newer techniques to stimulate tendon healing

Recovery Timeline

Healing tendon degeneration is a slow process:

  • 0-3 months: Initial improvement, reduction in pain
  • 3-6 months: Continued strengthening and healing
  • 6-12 months: Return to full activity in many cases
  • Ongoing: Maintenance exercises to prevent recurrence

Patience is essential. Attempting to return too quickly often leads to setbacks.

Preventing Tendon Degeneration

The best approach is prevention. Here’s how to protect your tendons:

Training Best Practices

  1. Progress Gradually

    • Follow the 10% rule (increase weekly volume by no more than 10%)
    • Include rest days
    • Vary your training intensity

  2. Warm Up Properly

    • Dynamic stretching before activity
    • Gradual increase in intensity
    • Movement-specific warm-ups

  3. Use Proper Technique

    • Work with a coach or trainer if needed
    • Ensure equipment fits properly
    • Address biomechanical issues

Strength and Flexibility

  1. Maintain Strong Muscles

    • Balanced strength training
    • Don’t neglect supporting muscle groups

  2. Stretch Regularly

    • Maintain flexibility
    • Focus on tight areas

  3. Balance Training

    • Improves proprioception
    • Reduces injury risk

Lifestyle Factors

  1. Adequate Nutrition

    • Protein for collagen synthesis
    • Vitamin C for connective tissue health
    • Proper hydration

  2. Rest and Recovery

    • Sleep sufficiently (7-9 hours)
    • Allow recovery between intense sessions
    • Listen to your body

  3. Address Systemic Issues

    • Manage diabetes
    • Maintain healthy weight
    • Don’t smoke

When to Seek Help

Consult a healthcare professional if:

  • Pain persists more than a few weeks
  • Pain interferes with daily activities
  • You notice weakness or instability
  • There’s swelling or visible changes
  • Over-the-counter treatments aren’t helping

Conclusion

Tendon degeneration is a common but often overlooked cause of chronic tendon pain. Unlike acute tendonitis, it develops over time due to repetitive stress and inadequate healing.

The key to managing tendon degeneration is:

  • Early recognition of symptoms
  • Patience with the healing process
  • Consistent targeted exercise (especially eccentric loading)
  • Addressing underlying causes (biomechanics, training errors, lifestyle)

With proper treatment and prevention strategies, most people can recover from tendon degeneration and return to their active lifestyles.

Next, learn about how degeneration specifically affects the posterior tibial tendon in our article: What Is a Degenerative Tendon?