When Radiculopathy Drives Tendon Pain: The Hidden Link Most Patients Never Hear About

 By Deborah Westergaard, MD | Pain Experts | Dallas–Plano

When Radiculopathy Drives Tendon Pain: The Hidden Link Most Patients Never Hear About

Most people are told their tendon pain is a “local problem.”

A sore gluteal tendon.

A painful hamstring insertion.

A stubborn Achilles.

But not all tendon pain begins in the tendon. In many high-functioning patients, the true source is upstream—at the spinal nerve root. When a spinal nerve becomes irritated or compressed, the muscle it innervates can no longer function normally. It weakens, fatigues early, or even begins to atrophy. As the muscle underperforms, the tendon it feeds becomes overloaded and stressed.

This is the part of the story that is almost never explained, even though it affects thousands of active adults:

Radiculopathy can directly create or worsen tendinopathy.

What Exactly Is Radiculopathy?

Radiculopathy occurs when a spinal nerve root is irritated or compressed by a disc bulge, bone spur, ligament thickening, or narrowing of the foramen. Depending on the level involved, symptoms can include:

• Radiating or electric pain

• Tingling or numbness

• Weakness in a specific muscle group

• Altered reflexes

• Fatigue with activity

It is not just pain. It is a signal problem.

R.adiculopathy drives tendon pain.

A compromised nerve cannot deliver a full, clean message to the muscle.

Without a healthy signal, the muscle cannot stabilize the joint or absorb load effectively. And when muscles fail to manage load, the tendon absorbs forces it was never meant to take onsetting the stage for tendinopathy.

How Radiculopathy Becomes Tendinopathy

Here is the biomechanics in simple terms:

1. Nerve root irritation → reduces muscle activation and control

2. Muscle weakness or inhibition → reduces stability and increases compensation

3. Altered loading mechanics → forces shift toward the tendon

4. Tendon overload → micro-trauma → degeneration → chronic tendinopathy

   
   

A common example I see in practice:

Lumbar radiculopathy → Gluteal tendinopathy

• A lumbar nerve root becomes irritated

• The gluteus medius or minimus becomes weak or inhibited

• Hip stabilization decreases in walking, standing, and single-leg loading

• The gluteal tendons become overloaded

• Lateral hip pain begins—and often becomes chronic

If you treat only the tendon, you may see temporary improvement…

But if the muscle remains under-innervated, the tendon is forced right back into the same dysfunctional load pattern.

What the Evidence Supports

Research shows:

• Radiculopathy disrupts muscle function and leads to atrophy in the affected myotomes

• Treating nerve root irritation can improve muscle activation and strength

• Tendon rehabilitation is more successful when the muscle–tendon unit is addressed, not the tendon alone

While randomized trials specifically measuring “treat radiculopathy → tendinopathy improves” are limited, the biomechanical model is well supported by both muscle physiology and clinical research.

This is why in complex cases, treating only the tendon is not enough.

Why I Treat Both the Nerve and the Tendon

My approach is based on long experience in spine and musculoskeletal medicine:

1. Restore the nerve–muscle connection

A weakened muscle cannot protect its tendon.

Evaluating and, when appropriate, treating the radiculopathy improves:

• Muscle activation

• Stability

• Load distribution

• Movement efficiency

This may include precision-guided spinal interventions, advanced imaging, or targeted rehabilitation.

2. Address the tendon directly

Once the muscle begins to recover its function, the tendon can be supported more effectively using:

• Tendon-specific loading protocols

• Biomechanical correction

• Ultrasound-guided orthobiologic treatments when indicated

• Adjacent-joint assessment to ensure no secondary overload

Treating both simultaneously creates a far better environment for durable recovery. No treatment can promise a specific outcome, but this integrated approach is designed to give your body the structural support it needs.

When Tendon Pain Doesn’t Behave Like Tendon Pain

This pattern should raise suspicion:

• A tendon improves, then relapses

• Pain worsens with long travel days

• Standing or walking triggers symptoms

• You notice subtle back or neck issues you’ve dismissed

• Physical therapy helps, but not reliably or long enough

• “Spot treatments” don’t last

These are signs the tendon may be acting as a compensator for a deeper nerve–muscle issue.

Ignoring the upstream driver can cost patients time, confidence, and performance.

Addressing both structures restores efficiency, stability, and capacity—qualities that matter to those who expect their bodies to keep pace with their lives.

Your Next Step: A Comprehensive Nerve–Muscle–Tendon Evaluation

If your tendon pain hasn’t responded the way it should, or if you have both tendon and spine symptoms—even mild ones—it may be time for a more thorough evaluation.

At Pain Experts, I perform a detailed analysis of:

• Nerve-root involvement

• Muscle activation patterns

• Tendon integrity

• Load mechanics across the entire kinetic chain

This type of evaluation is designed for patients who value precise answers and a strategic plan—not guesswork.

Now is the Time to Address the Full Picture.

If you’re experiencing tendon pain that keeps returning, now is the time to address the full picture. You can request a consultation through the scheduling link on this page or by contacting my office directly.

When a tendon is overloaded because its muscle is under-innervated, every month matters.

The sooner the nerve–muscle axis is addressed, the sooner the tendon can be supported properly

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