How to Treat Extensor Tendinitis with Exercises from Physical Therapists

Maybe you’ve noticed pain on the top of your foot that makes it hard for you to push off of your toes to jump or run. Or perhaps you have pain and stiffness on the top of your hand near your wrist that makes it hard for you to type at work. You may even think it’s due to something like carpal tunnel syndrome. But it could be related to a whole other cause: extensor tendinitis (tendonitis).

It’s easy to confuse the symptoms of extensor tendinitis with something else, acknowledges Laura Reising, PT, DPT, a physical therapist at Hinge Health. “It’s not a household term, so people come in to see me and aren’t quite sure what’s going on,” she says.

The good news is extensor tendinitis isn’t serious, and there are steps you can take to prevent and treat it. Here’s some more information about the condition, as well as exercises to help it go away.

What Is Extensor Tendinitis?

Extensor tendinitis is a type of tendinitis (inflamed tendon) that affects the tendons on the back of your hands and the top of your feet. “It’s essentially inflammation and stress on your extensor tendons,” explains Dr. Reising. “In your hands, extensor tendons help you straighten your fingers and extend your wrists back. In your feet, they’re what allow you to lift your toes and bring your ankle up.”

Extensor tendinitis is usually caused by repetitive motion that causes irritation to your tendons. “We tend to see this in people who suddenly increase their activity level, such as doing more running or hiking. It happens when you go past your body’s movement sweet spot, so that muscles and tendons get overworked,” notes Dr. Reising. “I also commonly see it in accountants during tax season because they’re in front of their computers for much longer than is typical for them.” 

Symptoms of Extensor Tendinitis

Extensor tendinitis symptoms depend in part on which part of your body is affected. But in general, you may notice:

• Sudden, acute pain

• Swelling

• Redness

• A crunching sound when you move the affected area (known as crepitus)

• Stiffness

Hand extensor tendinitis is generally at the top of your hand, often near your wrist. Foot extensor tendinitis is on the top of your foot, usually right where your shoelaces are.

Extensor Tendinitis: A Hinge Health Perspective

When you hear that you have extensor tendinitis, you may experience panic, like you have something "wrong" with you that needs to be fixed. But tendinitis of any kind is very common: almost like getting a cold, reassures Dr. Reising. In many ways, the treatment is the same. You’ll scale back on activity for a few days, then start moving again. 

“Motion is lotion, especially when it comes to extensor tendinitis,” says Dr. Reising. “It builds strength, flexibility, and resilience to pain.” That means you want to do exercises to keep your extensor tendons moving. This way, you’ll stretch and strengthen them, as well as the muscles and ligaments around them. “You may not be able to jump back in for your five-mile runs right away,” she acknowledges. “But if you keep the area moving, you’ll get blood flowing, which will help speed up recovery.”

Extensor Tendinitis Causes

“Extensor tendinitis is essentially an overuse injury,” says Dr. Reising. It can happen if you do more than your tendons are ready for, or if you do a frequent, repetitive activity. “We often see hand extensor tendinitis in occupations where someone uses their hands a lot, like an accountant during tax season, or a musician such as a guitarist or pianist,” explains Dr. Reising. Other hand extensor tendinitis causes include:

• Activities that involve repetitive finger movements, such as painting or wood working. 

• Racquet sports or baseball.

• Gardening. “I see a lot of flare ups in the spring, when everyone is out there gardening after a long winter,” says Dr. Reising.

Foot extensor tendinitis, on the other hand, is also often seen in certain athletes — for example, marathon runners, or even windsurfers, due to the foot strap placement. Other activities that often trigger foot extensor tendinitis include:

• Beach walking.

• Stair or ladder climbing.

• Ballet or modern dancing.

While underlying conditions such as osteoarthritis, flat feet, or high arches don’t usually cause extensor tendinitis in the feet, “it can make someone a little more susceptible,” says Dr. Reising.

It’s worth noting that repetitive activities involving your hands or feet are not inherently bad. But if they contribute to pain flares for you, it just means that you might need to do some targeted exercises to prepare your body for frequent or repetitive movements. 

Treatment Options

Here’s what Hinge Health physical therapists recommend when it comes to extensor tendinitis treatment.

• Activity modification. It’s important to keep moving when you have extensor tendinitis, but if your normal activities are contributing to pain flares, you may need to temporarily scale back on how much you’re doing or modify some movements. For example, a tennis player might choke up the racquet, shorten practice time, or avoid games for a set period of time if they have hand extensor tendinitis. Or they could try using a different mouse or keyboard if they have a desk job to take strain off the tendon, says Dr. Reising.

• Exercise therapy. “We want you to do some light exercises, such as stretching the affected area, to encourage blood flow,” says Dr. Reising. You can start with some of the exercises listed below. You may also benefit from working with a physical therapist since a PT can design an exercise program to help rebuild strength and flexibility to your extensor tendons. Research shows this approach is particularly effective for stubborn tendinitis.

• Ice massage. “This can be an effective pain management tool, especially in the early phases of extensor tendinitis,” says Dr. Reising. You can apply ice for 15-20 minutes, and as you do so, gently massage it into the affected area. Alternatively, you can apply ice to the painful area without massaging it. 

• Compression. This can help to relieve swelling and discomfort during the first week or two of a pain flare, says Dr. Reising. “Many of my patients find the actual foot and hand compression sleeves uncomfortable, so we often end up using an elastic bandage wrap,” she notes.

• Check your shoes. If you have foot extensor tendinitis, you may benefit from shoes with better arch support, or even an over-the-counter orthotic. A physical therapist can help you figure out any tweaks you may need to make.

The above exercises and stretches are recommended by Hinge Health physical therapists to treat extensor tendinitis in your hands.

The above exercises and stretches are recommended by Hinge Health physical therapists to treat extensor tendinitis in your feet. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Extensor Tendinitis Prevention

While you can't always prevent every injury or cause of pain, you can do things to minimize their likelihood of occurring and how long they last. Here’s what Hinge Health physical therapists recommend to help to prevent extensor tendinitis:

• Warm up and cool down. “If you’re about to do an activity that involves a lot of repetition — whether it’s playing piano, typing on your computer, or running — take a few minutes to do some exercises to get your blood flowing,” advises Dr. Reising. Follow up with stretching during your cool down to help loosen tight muscles.

• Take movement breaks throughout the day. “We refer to them as movement snacks,” says Dr. Reising. This helps give muscles and tendons a rest before you plunge back into your activity.

• Loosen shoelaces slightly. Tightly laced shoes can apply excessive pressure on your extensor tendons, points out Dr. Reising. If you notice the start of some discomfort, loosen them a bit to see if it helps. 

PT Tip: Listen to Your Body

It’s important to follow the above prevention tips, but it’s equally important to listen to your body if you start to experience pain. “It’s okay to push through some mild discomfort, but if you have significant pain, especially sharp pain, that’s a sign that you should scale back,” advises Dr. Reising. Otherwise, it could turn into a chronic problem that takes even longer to heal. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Kobayashi, H., Sakurai, M., & Kobayashi, T. (2007). Extensor Digitorum Longus Tenosynovitis Caused by Talar Head Impingement in an Ultramarathon Runner: A Case Report. Journal of Orthopaedic Surgery, 15(2), 245–247. doi:10.1177/230949900701500226

2. Hetsroni, I., Mann, G., Ayalon, M., Frankl, U., & Nyska, M. (2006). Extensor Digitorum Longus Tendonitis in Windsurfing Due to Footstrap Fixation. Clinical Journal of Sport Medicine, 16(1), 74–75. doi:10.1097/01.jsm.0000181434.95526.a4

3. Pavlova, A. V., Shim, J. S. C., Moss, R., Maclean, C., Brandie, D., Mitchell, L., Greig, L., Parkinson, E., Alexander, L., Brown, V. T., Morrissey, D., Cooper, K., & Swinton, P. A. (2023). Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis. British Journal of Sports Medicine, 57(20), 1327–1334. doi:10.1136/bjsports-2022-105754

4. Cook, J., Korakakis, V., & Martinez, D. (2019, September 26). Managing Difficult In-Season Tendinopathies. Aspetar Sports Medicine Journal. Retrieved from  https://journal.aspetar.com/en/journals/volume-8-targeted-topic-sports-medicine-and-science-in-athletics/managing-difficult-in-season-tendinopathies

5. Scott, A. & Purdam, C. R. (2023, November 16). Overuse (persistent) tendinopathy: Overview of management. Up To Date Retrieved from https://www.uptodate.com/contents/overuse-persistent-tendinopathy-overview-of-management

6. Fields, K. B. & Atkinson, B. (2024, February 7). Evaluation, diagnosis, and select management of common causes of midfoot pain in adults. Up To Date. Retrieved from https://www.uptodate.com/contents/evaluation-diagnosis-and-select-management-of-common-causes-of-midfoot-pain-in-adults