Tendinopathy: Understanding, Managing & Overcoming Pain

Tendinopathy, often referred to as tendonitis or tendinosis, is a condition that can affect anyone from athletes to office workers. Understanding what it is, recognising its symptoms, pinpointing areas of pain and implementing effective management strategies are vital steps toward recovery. In this blog post, we will dive into the world of tendinopathy, shedding light on this often misunderstood condition.

What is Tendinopathy?

Tendinopathy is a broad term used to describe conditions that affect tendons, the thick, fibrous cords that connect muscles to bones. It can occur in various parts of the body but is most commonly associated with the Achilles tendon, rotator cuff tendons, and tendons in the elbow (commonly known as tennis or golfer's elbow) and knee (patellar tendinopathy).

In the physiology of tendon pain, tenocytes (fibroblastic cells within tendon extracellular matrix) become sensitive to mechanical loading. With overload, the protein composition of the matrix is altered and results in pathology. Tendon pathology has been shown to induce changes to the cellular and extracellular anatomy. In essence, there is a reduced ability for the tendon to tolerate the forces placed upon it resulting in decreased function and pain.

Common Symptoms

Recognising the symptoms of tendinopathy is crucial for early intervention and effective management. Common signs and symptoms include:

1. Pain: Tendinopathy often presents as localised pain at or near the affected tendon. This pain may range from mild to severe and may worsen with activity.
2. Stiffness: Tendons can become stiff and less flexible, making it difficult to move the associated joint without discomfort.
3. Warm-Up Pain: Tendons may be particularly painful during the warm up for an activity but commonly is reduced during the activity once warm. Pain can then return following the cool down.
4. Swelling: In some cases there may be swelling or a feeling of thickening in the area around the affected tendon.
5. Weakness: Weakness may also be present - either primarily due to altered local and central mechanisms, or secondary due to pain inhibition.

Areas of Pain

Tendinopathy can affect various parts of the body, including:

1. Achilles Tendon: Pain in the back of the heel or calf is characteristic of Achilles tendinopathy. Different areas of the Achilles Tendon effected can influence rehabilitation management and exercise selection.
2. Rotator Cuff Tendons: Shoulder pain, especially when lifting or reaching overhead, may indicate rotator cuff tendinopathy.
3. Elbow Tendons: Pain in the outer elbow (tennis elbow) or inner elbow (golfer's elbow) is common with tendinopathy.
4. Patellar Tendon: Pain just below the kneecap during activities that involve jumping or squatting can suggest patellar tendinopathy.

Management Strategies

Managing tendinopathy requires a multifaceted approach that addresses both pain relief and the underlying causes. Here are some effective strategies:

1. Rest and Activity Modification: Give your tendon time to heal by reducing or modifying activities that exacerbate the pain. This may involve temporarily avoiding or modifying activities that overload the effected tendon.
2. Physical Therapy: A skilled physiotherapist can develop a tailored rehabilitation program that includes exercises to improve tendon loading capacity, tendon flexibility and length under tension, and tendon function as part of the kinetic/kinematic chain. Exercises should be specific for the tendon that is effected and follow a progressive approach to improving tendon function and reducing pain.
3. Icing: Applying ice to the affected area can help reduce pain and inflammation. Ice can be applied for 15-20 minutes every 2-3 hours during the initial stages of injury.
4. Soft Tissue Therapy: Soft tissue therapy to the area and surrounding muscles and joints can help to reduce pain and increase joint range of motion.
5. Biomechanics Analysis: Analysis of a persons mechanics can assist to reduce any underlying causes of tendon overload and improve kinetic chain function. This includes analysis of the surrounding joints and functional task assessment.
6. Eccentric Strengthening: Eccentric exercises, which involve lengthening the muscle-tendon unit under load, can be effective in rehabilitating tendinopathy. It is important to introduce this at the appropriate time during the rehab process as early loading may increase pain in some cases.
7. Load Management: Effective load management is key to management tendon related pain. A thorough assessment can help identify causes of tendon overload and reduce this in the short term. Following this, progressive re-introduction to load variables can assist to improve the loading capacities of the tendon.

Closing Thoughts

Tendinopathy is a common condition that can significantly impact your daily life and sport activities, but it is treatable with the right approach. Early intervention, appropriate management strategies, and a tailored rehabilitation plan can help you overcome tendinopathy and get back to the activities you love. An experienced physiotherapist can help guide you through your rehabilitation process to ensure you return to pain free function!

Are you experiencing tendinopathy? Book an appointment with our friendly physiotherapists at our Brisbane CBD clinic today!

By Stephen Valassakis BSc (Hons), MSc, APA