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What is Tendinopathy?
Tendinopathy is a broad term used to describe a range of tendon conditions that cause pain, swelling, and impaired function. It is common pathology present in up to 30% of medical care consultations involving musculoskeletal conditions. Tendons are tough, fibrous tissues that connect muscles to bones, allowing for movement. When these tendons become injured or overused, it can lead to tendinopathy. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendon and Achilles tendon.
Causes and Risk Factors
Overuse: Repetitive motion and overuse are primary causes, especially in athletes or those whose jobs involve repetitive tasks.
Age: Tendon elasticity decreases with age, increasing the risk of tendinopathy.
Biomechanical Issues: Improper technique during physical activity, poor posture, or structural abnormalities can contribute.
Health Conditions: Conditions like diabetes or rheumatoid arthritis can increase the risk.
Symptoms
Pain: This is the most common symptom, often described as a dull ache, particularly when moving the affected limb or joint.
Tenderness: The area around the tendon may be sensitive to touch.
Swelling: Mild swelling around the tendon can occur.
Stiffness: Especially noticeable in the morning or after periods of inactivity.
Weakness: Reduced strength in the affected area can impair function.
Diagnosis
Diagnosis typically involves a combination of:
Physical Examination: To check for tenderness, swelling, and range of motion.
Imaging Tests: Getting the correct diagnosis is crucial, as it enables us to choose the most appropriate and effective treatment strategy for you.
Combining diagnostic ultrasound with a physical examination in our practice allows us to develop an evidence-based treatment program that will relieve your symptoms and help you return to the activities you love.
An ultrasound scan will be able to give you the following information:
Which part of the tendon is injured
How severe the condition is and if there is inflammation present.
If there are any tears in the tendon.
If there are any other structures involved.
If you would like to book an appointment including an ultrasound scan, please ensure you inform us when booking.
Treatment
Treatment of choice is based on conservative management and is consistent with the following:
Activity Modification: Reducing or modifying activities that exacerbate symptoms is crucial.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation but are not recommended at the early stages of inflammation.
Cryotherapy and Heat Therapy: Ice packs can help reduce acute inflammation, while heat can benefit chronic cases.
Physical Therapy:
When treating tendinopathy, it’s important to consider various factors and set a primary treatment goal tailored to individual needs. Our primary objective in tendinopathy rehabilitation is to enhance the tendon and muscle's capacity to handle the load.
Physical therapy management includes various exercises, loading programs, and therapeutic modalities. Research indicates that progressively increasing load on a tendon is the most effective way for it to recover. This loading must be applied in all functional movements of the tendon, including deceleration (eccentric loading), acceleration (concentric loading), and fast, impact movements. Additionally, it should be done throughout the tendon’s entire range of motion.
Lifestyle factors also play a crucial role in tendon recovery. Maintaining a healthy diet, getting adequate sleep, resting sufficiently, and managing stress are all vital for treating and preventing tendon issues.
If you do not see improvement with the above approach, the next step may be a course of Extracorporeal Shockwave Therapy (ESWT). Evidence supports our clinical experience at Physio4Quality, showing that shockwave therapy combined with a structured rehabilitation program is an effective treatment for chronic tendinopathy.
More info here: https://www.physio4quality.com/shockwave-therapy
Common mistakes:
Just resting it up
The most common mistake in treating tendon problems is complete rest. While rest can help temporarily alleviate pain and reduce aggravation during a flare-up, it does not improve tendon health in the long term. Pain often returns once the tendon is used again and in fact tendons are most vulnerable after a period of inactivity, such as returning to work after a holiday or resuming sports following an illness or injury. When treating the tendon, the main goal is to manage the flare-up while gradually reintroducing activity as tolerated. This graded exposure allows the tendon to adapt to loads and recover properly.
The graph above, prepared by Davenport et al. (2005), illustrates that while rest may provide temporary pain relief, the structural integrity of the tendon could remain compromised. Resuming activity is likely to cause further tendon degeneration and episodes of progressively worsening pain, requiring increasingly longer rest periods for relief. Over time, this degeneration might result in mechanical failure of the tendon, leading to acute pain and potential rupture.
On the other hand, doing too much too often in the hope of speeding up recovery can also be detrimental.
After training, there is a predominance of catabolic changes for the first 24 hours. It takes 36-48 hours for collagen synthesis to become greater than collagen breakdown. At this point, it is appropriate to start another training session.
Understanding tendinopathy is crucial for effective prevention and treatment. By recognizing the symptoms early and adopting appropriate management strategies, you can minimize the impact of this condition and maintain an active, healthy lifestyle.
Book your appointment now for an assessment and treatment plan to get you back on track.
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