Tendinopathy and Tendonitis

Tendinopathy describes pain and dysfunction arising from a tendon, usually caused by overload or degeneration rather than straightforward inflammation. It is one of the most common and most undertreated musculoskeletal conditions. Without the right approach, tendon problems can become persistent and frustrating.

At Spine Plus, we combine shockwave therapy, Class IV laser, medical acupuncture and structured rehabilitation to achieve results for patients where general treatment has not worked. Our clinics in Woodford Green and Chigwell have extensive experience treating all tendon conditions.

Conditions We Treat

Calcific Tendinopathy of the Shoulder

Calcific tendinopathy involves calcium deposits forming within a tendon, most commonly in the supraspinatus, infraspinatus or subscapularis tendons of the rotator cuff. It can be a very painful and volatile condition, sometimes coming and going over months or years.

Shockwave therapy has demonstrated very high success rates for calcific tendinopathy, helping to break down and reabsorb calcium deposits. We typically begin with focused shockwave therapy, which is approximately 100 times more powerful than radial shockwave and works at the precise depth of the deposit. Most patients see significant improvement within 3 to 5 sessions.

Injections such as barbotage and steroid injections can help, but carry a risk of tendon weakening and rupture, which is why we typically start patients with the less invasive option of shockwave therapy to break up the calcium deposits before considering these.

Tennis Elbow (Lateral Epicondylitis)

Tennis elbow causes pain on the outer side of the elbow, typically worsened by gripping, lifting or extending the wrist. Despite the name, it is not limited to tennis players and is very common in people with repetitive arm activities at work.

Focused shockwave therapy, dry needling, deep friction massage and load management exercises are all highly effective for tennis elbow. We identify contributing factors including wrist and forearm muscle imbalances that drive ongoing tendon stress. We also offer a range of purpose-designed, sweat-resistant elbow supports for tennis elbow.

Golfer's Elbow (Medial Epicondylitis)

Golfer's elbow presents as pain on the inner side of the elbow, often with forearm weakness. It responds well to the same approaches used for tennis elbow, with shockwave therapy and targeted rehabilitation typically achieving excellent outcomes. We also offer a range of sweat-resistant elbow supports designed for golfer's elbow.

Repetitive Strain Injury (RSI)

RSI is a broad term covering pain, inflammation and dysfunction in the tendons, muscles and nerves of the forearm and wrist from repetitive activity. Our approach focuses on reducing load, restoring normal movement patterns and addressing musculotendinous irritation with manual therapy and electrotherapy. Treatment includes electrotherapy such as ultrasound to relieve tendon inflammation, alongside our specially designed range of wrist supports.

DeQuervain's Syndrome

DeQuervain's syndrome affects the tendons on the thumb side of the wrist, causing pain with gripping and pinching movements. It is common in new mothers (due to repetitive baby-lifting) and in people with repetitive wrist activities. Treatment includes splinting advice, manual therapy and targeted exercises.

Steroid injections can reduce swelling, though carry a small risk of adverse reactions, so we often recommend manual therapy first. Immobilising the thumb in a support can also help; see our specially designed Thumb Support, made from patented sweat-resistant materials.

Tenosynovitis and Paratendonitis

Inflammation of the tendon sheath (tenosynovitis) or the tissue surrounding a tendon (paratendonitis) can cause localised pain and tenderness along the tendon's length. Treatment focuses on load management, anti-inflammatory electrotherapy and progressive rehabilitation. Where friction-style massage isn't sufficient, we also often refer patients with paratendonitis for stripping or high-volume injections.

Achilles Tendinopathy

The Achilles tendon is the largest and strongest tendon in the body, connecting the calf muscles to the heel. Achilles tendinopathy typically presents as pain and stiffness at the back of the heel or mid-tendon, especially on first steps in the morning.

Shockwave therapy, eccentric loading exercises and laser therapy are among the most effective treatments available. We also assess foot biomechanics and gait to address any contributing factors. Custom orthotics may be recommended where foot mechanics are contributing to tendon load.

It's important to first screen for partial or full Achilles tendon ruptures, which may require splinting or surgical repair. Where manual therapy and orthotics aren't enough, we can also refer for injections such as PRP, though these carry a small risk of adverse reactions so we typically try conservative treatment first.

Plantar Fasciitis (Heel Pain and Heel Spur)

The plantar fascia is a band of connective tissue running along the sole of the foot. Plantar fasciitis causes pain under the heel, typically worst with first steps in the morning. A heel spur may develop at the attachment point but is not always the cause of pain.

Shockwave therapy, laser, manual therapy and specific stretching and strengthening exercises are all effective. We also assess foot arch mechanics and offer custom orthotics where biomechanical correction would benefit recovery and prevent recurrence. Steroid injections are an option but can risk rupturing the plantar fascia, especially in high-demand sports people, which is why we favour dry needling, shockwave therapy and deep (including Graston-style) massage as a first approach.

Why Shockwave Therapy Works for Tendons

Shockwave therapy produces acoustic pressure waves that stimulate blood vessel formation, promote collagen synthesis, break down calcium deposits and reduce pain from nerve endings in the tendon. A single shockwave session has been estimated to have the same or greater therapeutic effect as 6 to 8 sessions of deep friction massage.

Most patients with tendinopathy experience significant improvement within 3 to 5 sessions. We offer both radial shockwave and focused shockwave therapy, with focused shockwave able to target deeper structures with greater precision and energy.