Tendinopathy can cause chronic tendon pain, stiffness, tenderness, weakness, swelling, and pain with movement, loading, or activity.
Learn how Dr. Siefferman evaluates tendinopathy, identifies the underlying cause of tendon pain, and develops personalized treatment plans to promote healing and restore function.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hi, I’m Dr. Jason Siefferman, an interventional pain specialist and medical director at Manhattan Pain Medicine. Tendinopathy refers to chronic tendon strain, which is generally a biomechanical process where that muscle, tendon, bone intersection is repetitively strained and the tendon part which is the end of the muscle just before it attaches to the bone is strained. This process leads to atypical formation of collagen fibers.
Whereas these fibers are supposed to be linear aligned and very strong in that confirmation, they get disrupted from repetitive strain, repetitive overuse and become disarrayed. This can also generate pain. To treat this one, we look at the biomechanics for what is stressing that tendon in the first place because we have to stop that. And then secondarily, if it doesn’t heal on its own or with physical therapy, we can use regenerative medicine to stimulate a healing response within that tendon. Typically, we’ll start with dextrose prolotherapy. And if that’s not successful, then we can move to platelet-rich plasma.
Tendinopathy is a broad term for tendon pain and dysfunction that may involve irritation, overload, failed healing, degeneration, inflammation in selected cases, or chronic tissue sensitivity. It can affect many areas, including the shoulder, elbow, wrist, hip, knee, ankle, Achilles tendon, and foot.
Symptoms often include pain with movement, tenderness, stiffness, weakness, swelling, or pain where the tendon attaches to bone. Long-standing tendon pain is not always simple inflammation, which is why the term tendinopathy is often more accurate than tendinitis.
Because tendon pain can overlap with tendon tear, bursitis, arthritis, enthesitis, nerve pain, hypermobility, or referred spine pain, careful evaluation matters before treatment begins.
At Manhattan Pain Medicine (MPM), evaluation begins by identifying whether pain is truly coming from the tendon or from another nearby structure. For patients looking for tendinopathy treatment in Manhattan, MPM evaluates the specific tendon involved, pain location, activity triggers, load tolerance, joint mechanics, hypermobility, EDS, inflammatory overlap, prior imaging, prior therapy, and response to treatment.
Care may include diagnostic ultrasound, ultrasound-guided injections, PRP, BMAC, prolotherapy, regenerative medicine discussions, rehabilitation coordination, and referral when tendon tear, advanced structural damage, or another condition requires additional evaluation.
Tendon pain can be frustrating because it may linger for months, flare with normal activity, and fail to improve with generic rest or exercises. Some patients are told they have tendinitis, while others hear tendinosis, tendinopathy, tendon tear, bursitis, enthesitis, or arthritis. These terms can overlap, but they do not always mean the same thing.
MPM uses a diagnosis-first approach to clarify the actual pain generator. The evaluation considers whether symptoms are coming from the tendon itself, the tendon sheath, the attachment point to bone, a nearby bursa, the joint, a nerve, an inflammatory condition, hypermobility-related overload, or referred pain from the spine.
This distinction matters because treatment for an irritated tendon may differ from treatment for a partial tear, enthesitis, nerve irritation, joint arthritis, or instability-related pain.
Tendinopathy fits within MPM’s Musculoskeletal issues Zone of Expertise, with important overlap in Hypermobility when EDS, joint laxity, instability, compensatory loading, or recurrent tendon irritation are present. This matters because tendon pain is often influenced by how the joint moves, how the surrounding muscles load the area, and whether connective tissue differences affect stability.
MPM uses the Zones of Expertise framework to evaluate whether symptoms appear tendon-based, attachment-based, joint-related, nerve-related, inflammatory, instability-related, or referred from another region. This helps guide whether the next step should be diagnostic ultrasound, movement-based care, medication management, ultrasound-guided injection, regenerative discussion, or referral for orthopedic or rheumatology input.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Tendinopathy is a broad term for tendon pain or dysfunction. It may involve tendon irritation, overload, failed healing, degenerative tendon change, inflammation in selected cases, or chronic tissue sensitivity. Tendinopathy can affect many areas, including the Achilles tendon, rotator cuff, patellar tendon, elbow tendons, hip tendons, wrist tendons, and foot or ankle tendons. Symptoms often worsen when the tendon is loaded, stretched, or used during activity. Diagnosis-first evaluation helps determine whether pain is truly tendon-related or coming from another structure.
Tendinitis usually refers to tendon inflammation, often in a more acute or irritated state. Tendinosis usually refers to longer-term degenerative or disordered tendon change, rather than simple inflammation. Tendinopathy is the broader term used for tendon pain and dysfunction because chronic tendon problems may involve multiple processes, including overload, tissue sensitivity, failed healing, and structural change. The distinction matters because treatment may differ. A chronic tendon condition may not respond to the same approach as a short-term inflammatory flare.
Tendinopathy may cause pain with movement, loading, exercise, gripping, lifting, running, jumping, stairs, reaching, or resisted muscle use. The tendon may feel tender, stiff, swollen, weak, or painful near its attachment to bone. Some patients feel morning stiffness or pain at the start of activity that changes as they warm up. Others have pain that worsens after activity or later in the day. Symptoms vary depending on the tendon involved and whether there is a tear, bursitis, joint problem, nerve irritation, or inflammatory overlap.
Tendinopathy may be caused by repetitive loading, sudden training changes, poor load tolerance, overuse, tendon degeneration, age-related tissue change, biomechanics, weakness, joint instability, inflammatory disease, or hypermobility. It can also develop after a sudden injury or from repeated stress over time. Patients with EDS or hypermobility spectrum disorder may be more prone to tendon overload because joint laxity can increase the demand on muscles and tendons for stability. Identifying the cause helps guide treatment and reduce repeated irritation.
Tendinopathy is diagnosed through medical history, physical examination, movement testing, resisted strength testing, palpation, imaging review, and diagnostic ultrasound when appropriate. The clinician evaluates the tendon, nearby joint, attachment point, surrounding soft tissues, nerve symptoms, and movement pattern. MRI may be reviewed or ordered when deeper structures, partial tears, or complex pathology are suspected. Diagnosis also includes ruling out overlapping conditions such as bursitis, arthritis, enthesitis, inflammatory disease, nerve irritation, referred spine pain, or infection when symptoms suggest another cause.
Diagnostic ultrasound can be helpful in selected tendon pain cases. It may show tendon thickening, partial tears, fluid, calcification, tendon sheath irritation, dynamic movement, and nearby soft tissue findings. Ultrasound can also guide injections when a specific target is identified. It is not required for every patient, and it does not replace all imaging. MPM uses diagnostic ultrasound when it may clarify the pain generator, support a treatment decision, or improve precision for an ultrasound-guided procedure.
Treatment depends on the tendon involved and the cause of symptoms. Options may include activity modification, load management, physical therapy, movement retraining, strengthening, medication management when appropriate, bracing or supports in selected cases, diagnostic ultrasound, and ultrasound-guided injections. Some chronic tendon conditions may require careful progressive loading rather than complete rest. PRP, BMAC, prolotherapy, or regenerative medicine may be discussed only in selected cases after the diagnosis, tendon location, severity, imaging findings, risks, evidence, and goals are reviewed.
PRP, BMAC, and prolotherapy may be considered in selected cases of chronic tendon or tendon-adjacent pain after careful evaluation. These options are not automatic treatments for every tendon problem and should not be presented as guaranteed tendon repair, surgery prevention, or durable pain relief. Their role depends on the tendon involved, chronicity, tissue findings, prior care, patient goals, risks, and available evidence. MPM discusses regenerative options carefully and only when the suspected pain generator and treatment goal are clear.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Tendinopathy is a broad term for tendon pain and tendon dysfunction. Tendons connect muscles to bones and help transfer force during movement. When a tendon is irritated, overloaded, injured, or unable to tolerate repeated stress, it may become painful with activity, pressure, stretching, or resisted movement.
Tendinopathy can affect many areas of the body. Common examples include Achilles tendinopathy, rotator cuff tendinopathy, patellar tendinopathy, tennis elbow, golfer’s elbow, hip tendinopathy, wrist tendon pain, and foot or ankle tendon pain. Symptoms may include tenderness, stiffness, swelling, weakness, pain with loading, or pain where the tendon attaches to bone.
Patients are often told they have tendinitis, tendinosis, or tendinopathy. Tendinitis usually suggests inflammation. Tendinosis usually refers to more chronic degenerative or disordered tendon change. Tendinopathy is often the most useful umbrella term because long-standing tendon pain may involve irritation, overload, tissue sensitivity, failed healing, and structural tendon change rather than inflammation alone.
This distinction matters. If chronic tendon pain is treated only as inflammation, the plan may miss important contributors such as load intolerance, weakness, joint instability, movement mechanics, or tendon degeneration.
Tendon pain may become chronic when the tendon is repeatedly loaded beyond its current capacity. This can happen after a sudden increase in training, repetitive work activity, poor recovery, altered biomechanics, joint instability, weakness, or incomplete rehabilitation after injury. Some patients continue to irritate the tendon because normal daily activity still exceeds what the tissue can tolerate.
Hypermobility can also contribute. In patients with EDS or hypermobility spectrum disorder, joint laxity may increase the demand on muscles and tendons for stability. The tendon may become overloaded because it is compensating for a joint that moves too much or lacks control. This can lead to recurrent tendon irritation, muscle guarding, and chronic pain.
Not all pain near a tendon is tendinopathy. Similar symptoms can come from tendon tear, bursitis, arthritis, enthesitis, nerve irritation, inflammatory disease, joint instability, referred spine pain, infection, fracture, or vascular problems. Enthesitis, for example, involves inflammation where a tendon or ligament attaches to bone and may be associated with inflammatory arthritis. A tendon tear may require a different approach than chronic tendinopathy.
MPM evaluates the full pattern before recommending treatment. This includes pain location, load triggers, activity history, tenderness, strength, range of motion, swelling, joint mechanics, nerve symptoms, and prior response to therapy or injections.
MPM begins with a detailed history and physical examination. The clinician reviews when pain began, what activities provoke it, whether symptoms followed injury or overuse, what treatment has already been tried, and whether pain is improving, worsening, or recurring.
The exam may include resisted movement testing, palpation of the tendon and attachment site, joint assessment, movement analysis, and evaluation for hypermobility, instability, nerve irritation, or inflammatory signs. Diagnostic ultrasound may be used when it can help assess tendon thickening, partial tearing, fluid, calcification, tendon sheath irritation, dynamic movement, or nearby soft tissue pathology. Imaging is interpreted in context because structural findings do not always explain the full pain experience.
Treatment depends on the tendon involved, symptom duration, severity, functional goals, imaging findings, and contributing factors. Many patients need activity modification and load management. This may mean reducing painful activities temporarily, changing technique, adjusting training volume, or gradually rebuilding tendon tolerance.
Physical therapy or rehabilitation may focus on progressive strengthening, tendon loading, mobility, motor control, and return-to-activity planning. The goal is usually not complete rest, but the right amount of load at the right time. Too much activity can keep the tendon irritated, while too little activity can reduce strength and tissue tolerance.
Medication management may be considered when appropriate, especially for pain control or short-term symptom flares. Steroid injections near tendons require caution because of tendon-related risks and should only be used when clinically appropriate.
Diagnostic ultrasound and ultrasound-guided procedures may help when a specific target is identified. In selected chronic cases, PRP, BMAC, prolotherapy, or regenerative medicine may be discussed. These options are not automatic treatments for tendon pain. They should be considered only after the tendon location, severity, chronicity, imaging findings, prior care, evidence, risks, and goals are reviewed.
Patients should be cautious about any claim that regenerative medicine repairs all tendon damage or prevents surgery in every case. Some tendon injuries require orthopedic evaluation, especially when there is a significant tear, major weakness, functional loss, or failure of appropriate nonsurgical care.
Tendon pain should be evaluated when symptoms persist, worsen, limit function, follow a sudden pop or injury, cause weakness, swelling, bruising, deformity, inability to use the limb, numbness, fever, redness, or rapidly worsening pain. These symptoms may suggest a tendon tear, infection, fracture, nerve issue, vascular problem, or another condition that should not be treated as routine tendinopathy.
MPM approaches tendinopathy through a diagnosis-first, function-focused model. The evaluation considers the specific tendon, attachment site, tendon sheath, surrounding joint, nearby bursa, nerve pathways, inflammatory overlap, hypermobility, EDS, movement mechanics, and chronic pain contributors.
For patients looking for tendinopathy treatment in Manhattan, MPM offers a careful pain medicine perspective that can work alongside physical therapy, orthopedics, rheumatology, sports medicine, and rehabilitation. The goal is to identify the true pain generator, match treatment to the tendon and load pattern, and build a plan that supports function, activity tolerance, and long-term movement capacity.
