What is a Tendinopathy?
“Tendinopathy” is a broad term that includes all types of tendon damage and injury. The tendon is the tough band of tissue that muscles use to attach to bone. They can (and do) withstand high magnitude and repetitive force in most sports and exercise activities.
It is normal for tendon tissue to suffer microscopic injury with use. Your body has an ongoing repair mechanism that maintains and increases tendon strength as a response. If the tendon is damaged quicker than it can repair, it may either weaken or repair poorly. Early on this can cause tendon pain. If the process continues it can lead to chronic tendon degeneration.
What are the Symptoms of Tendinopathy?
Tendinopathy often results in stiffness, pain and weakness in particular movements. Often it feels worse when initiating new movement after periods of rest like getting out of a chair or getting up in the morning.
Where does tendinopathy occur?
Tendon injuries can occur anywhere in the body but there are a few sites that are more prone to tendon injury than others. These include the elbow, the Achilles tendon, the patella tendon (in the knee), shoulder tendons and the hamstring tendon (in the posterior thigh or buttock).
Are there other causes of tendon pain?
Absolutely! A trap that many medical professionals fall into is assuming all tendon pain is ‘tendinopathy’. Tenosynovitis (inflammation in the lining of the tendon) and Enthesitis (inflammation of the tendon insertion) are just two examples and the treatment for these is vastly different to the treatment for degenerative tendinopathy. As always, an expert and thorough diagnosis made by an experienced practitioner is the key.
What are the different types of tendinopathy?
1. Reactive Tendinopathy
This is where the tendon reacts to excessive demands with pain and inflammation that has not resulted in any structural damage. Usually the key here is load management. Rest might lead to tendon weakening and a poor repair whereas continued excessive loads can lead to further aggravation and damage.
2. Tendon Dysrepair
This is still a relatively fresh tendon injury where the healing process has been compromised resulting in a poor repair. The tendon is still actively repairing and remodelling.
3. Degenerative Tendinopathy
When the compromised repair goes on for too long, the rate at which the tendon remodels itself diminishes leaving a poor repair with very few cells actively healing the tendon
How is tendinopathy diagnosed?
Tendinopathy can usually be diagnosed by an expert practitioner without the need for any further investigation. Occasionally further investigation can be required to check for other conditions or contributing factors.
How is tendinopathy treated?
The most important step for any practitioner is to thoroughly understand the individual tendinopathy because how longstanding the problem is, what sort of loads the tendon currently tolerates and how the tendon has responded to past treatment will all greatly affect treatment. No two tendons are the same. If ever there was a medical condition where a ‘cookie-cutter’ approach was destined to fail – this is it!
Some tendons require more load, some less. Some need anti-inflammatories, some don’t. Some will benefit from injection therapies, many (most) don’t. An practitioner who has the knowledge, experience and patience to get to know your specific tendon issue will have the most success at treating it.
Sometimes best intentions can significantly worsen the problem. Treatments like ice (which limits blood flowing to a tendon trying to repair) and over-stretching are examples therapies that can potentially contribute to the problem when applied incorrectly.