Do Tendons Ever Fully Heal?Jo Clacher
Article by Zoe Russell
Do Tendons Ever Fully Heal?
Tendon injury is painful and debilitating, and the injury can exist along a spectrum of pain and dysfunction in a normal tendon, to pain and dysfunction in the presence of structural tendon change (known as partial thickness tears), and even complete tear (known as rupture) of the tendon.
One question Physiotherapists often get asked is “do tendons ever fully heal?”
Having a ‘healed tendon’ means that you can use the tendon to do the activities that you want to, without pain.
Tendinopathy (or Tendon pain and dysfunction) is not correlated with what we see on imaging. This means that your clinical assessment – or what you tell your physiotherapist and the tests they do in the consultation provides guidance on your recovery.
With age, the collagen that comprises the structure of our tendons changes – similar to the wrinkles we see on our face. This can occur sub – clinically, meaning that we do not know the changes have occurred until we add a load to our tendon and develop pain. It is common to have changes in the structure of your tendon and “imaging evidence” of changes in tendon structure does not equal damage or healing, rather your symptoms and their response to activity determines your healing.
Imaging, such as X – Rays, Ultrasound or MRI may take place as part of your management plan, and are used to exclude a diagnosis that requires further intervention or opinion from additional health practitioners, for example – determining between a tendon pain or full tendon rupture.
Tendon healing occurs through the application of therapeutic loading to your tendon. To help your tendon “heal” your Physiotherapist undertakes an assessment of your tendon and identify what you can do, and what you cannot do. The best recovery strategy for your tendon is to gradually apply loading, specific to your needs and goals. This is called “treat the Doughnut and not the hole!” which currently is the evidence based best practice management of your tendon injury!
What “Treat the Doughnut and not the hole!” means to focus rehabilitation efforts to increase the capacity of the remaining healthy tendon, to restore your ability to do the things you love!
But what about a full tendon tear?
Well, in fact, your age, activity level and nature of your tear is important.
In younger, more active individuals who have a sudden onset of a tendon tear to their shoulder, there may be a place to consider orthopaedic consultation for your shoulder tendon tear.
As we age, if there is no sudden mechanism, the full thickness tear may not require intervention, as the remaining rotator cuff tendons may be able to control the humerus position through shoulder movement, without symptoms.
Not sure what to do about your shoulder tendon pain? Call your local PhysioWorks Clinic to book an appointment today!
More information: Common Tendinopathies