Tendinopathy is a term describing pathology (damage or degeneration) arising from a tendon. Our tendons join muscles to bone and have the role of storing and releasing energy. Sudden or gradual overload of these tendons can cause microtears and degeneration resulting in pain and reduced performance.
Initially mild symptoms can arise in mornings, as ‘warming-up’ or following activity. In this initial reactive phase sports medicine practitioners can intervene to reduce symptoms, settle the tendon and avoid further degeneration of the tendon.
Modalities used by health professionals in the reactive early stage of tendinopathy include;
- optimising training loads
- strengthening and muscle activation exercises from identified weaknesses on testing
- optimising biomechanics and footwear pharmacological management
- manual therapy to release structures causing tendon compression
- shockwave treatment
If symptoms are not controlled in the early phase the tendon will move into a more degenerative state. Symptoms in this stage are normally constant with activity and are just worse in the mornings and after activity. This state leads to a reduction of muscle and tendon function due to prolonged pain inhibition. This will often lead to reductions in muscle bulk and strength, reduced elasticity of the tendon and power of the muscle-tendon complex as well as persistent chronic pain. This unfortunately normally leads to inability to participate or to be able to do so at the same level before the tendon became symptomatic.
Additional modalities adopted in this degenerative stage are:
- period of complete rest and offload
- extensive progressive strengthening program
- injection therapies where appropriate
- surgical referral where appropriate
- an emphasis on patience!
All treatments across both reactive and degenerative states of tendinopathy are to improve the tolerance of the tendon to the aggravating activity by reducing pain, improving muscle function and optimising the load placed on the tendon. Too little or too much load will create a big barrier to long term success in tendon rehab.
For the treatment of tendon problems there is currently no magic bullet. The treatment program needs to be tailored to the individual and be guided by the demands of the individual, their goals, their stage of pathology and the contributing factors identified in the assessment. The timeframe to recover can range from a week to a year depending on the individual situation and often requires great commitment and patience for success.
