Tendinopathies

How to treat them successfully

What is a tendinopathy?

The term “tendinopathy” describes a clinical condition characterized by pain, swelling, and functional limitation of the tendon. Tendinopathies account for over 30% of all musculoskeletal consultations.

Tendon disorders are very common in sports. Physical activity subjects the muscle-tendon unit to stress and force, increasing the risk of tendon injury.

Around 50% of sport-related injuries are due to overuse conditions and the majority of these involve tendons.

Tendons are strong fibrous structures that connect the muscles to the bones. They have the main function of transforming the force generated by muscle contraction into movement. They are able to absorb external forces in order to limit muscle overloads and act as temporary energy storage devices.

Tendinopathy is not an inflammatory process, so much so that the term tendinitis should be altogether forgotten.

Except in the first two to three weeks of tendon tear or rupture,  very little inflammation is found in tendinopathies.  When studied at the cellular level, the tendons are in fact degenerative. This means that the tendon is not made of nice well organised tendon cells anymore but a mix of disorganised tendon, collagen, and lipid fatty cells due repetitions of small ruptures and repair happening in the tendon.

The most frequently affected areas are:

  • rotator cuffs,

  • Long head of the biceps brachialis,

  • extensors and flexors of the wrist,

  • thigh adductors,

  • gluteal tendons

  • posterior tibial tendons,

  • patellar tendons,

  • Achilles tendons, and

  • the plantar fasciae.

So what can be done about it?

 

1.       Find the cause of the tendinopathy.

This is more complicated than it sounds.  In one case, for example, a patient had a right Achilles tendinopathy which was in fact caused by a muscle weakness in the left hip.  The patient used to “compensate for” his weakness by putting more weight on his right foot when walking.

2.       Modify the load.

This can be done by, for example, changing the footwear of a hillwalker, the serving technique of a tennis player or training programme of a runner.  Experience shows that removing the load completely (what we would also call REST!) has poor outcomes in the long term because the problem is not in itself caused by inflammation that could be treated by resting.  Over time, rest will weaken the tendons further and the pain can actually increase.  Reducing the loading strategy over a period of time and then increasing it again to the level required is the best way to successfully manage a tendinopathy.

3.       Extracorporal Shockwave therapy (ESWT)

Many studies have not shown that EWST combined with a strengthening programme had the best outcomes in the treatment of tendinopathies.

We offer EWST at the clinic. Please click HERE to learn more about it.

4.       Dry needling

Some good results have been recorded using dry needling for some tendinopathies. Dry needling uses acupuncture needles inserted into the painful tendon, causing small amounts of tissue damage which will stimulate the healing process and the production of new tendon cells.

5.       Strengthening Programme

Because the tendons are not inflamed but degenerative, they require strengthening.  Exercise has been shown to help production and reorganisation tenocytes (the tendon cells) alongside neovascularisation in injured tendons.  The main problem is that if the tendon is loaded too hard too soon, further damage will be caused.  Strengthening exercises must be progressive and respect the tendon.  Therefore, if you want to return to moving normally and pain free following a tendinopathy you will need some…

6.       Patience

Tendon pain will improve over time but only if you take the right steps.  Rest and pain avoidance will not help in the long term but doing too much too quickly will not help either.  You simply need to listen to your physio and do as you are told…