What is Tendinopathy?

Tendinopathy (tendon injuries) can develop in any tendon of the body. Tendinopathy has many aliases: tendonitis, tendinitis, tenosynovitis and tendinosis. In simple terms, they are all tendon injury pathologies, so the medical community now refers to them as tendinopathies.

Typically, tendon injuries occur in three areas:

• tendon insertion (where the tendon attaches to the bone)
• mid-tendon (non-insertional tendinopathy)
• musculotendinous junction (where the tendon attaches to the muscle)

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to occur suddenly, but usually, it is the result of repetitive tendon overloading. As mentioned earlier, health care professionals may use different terms to describe a tendon injury.

What is Tendonitis?

Tendinitis (or tendonitis): This means “inflammation of the tendon”. Mild inflammation is a normal tendon healing response to exercise or activity loading, but it can become excessive, where the rate of injury exceeds your healing capacity. Tendonitis is the inflammatory phase of tendinopathy.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes the tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

• Normal tissue adaptation phase
• Prognosis: Excellent.
• Normal Recovery!

2. Tendon Dysrepair

• Injury rate > Repair rate
• Prognosis: Good.
• The tendon tissue is attempting to heal.
• You must prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

• Cell death occurs
• Prognosis: Poor!
• Tendon cells are dying!

4. Tendon Tear or Rupture

• Catastrophic tissue breakdown
• Loss of function.
• Prognosis is inferior.
• Surgery is often the only option.

What is Your Tendinopathy Phase?

It is imperative to have your tendinopathy professionally assessed to identify its current injury phase. Identifying your tendinopathy phase is vital to direct your most effective treatment since specific treatment modalities or exercises should only be applied or undertaken in distinct tendon healing phases.

Systemic Risk Factors

The evidence is growing that it is more than just the tendon and overload that causes tendinopathy. People with a predisposition to tendinopathy include diabetes, post-menopausal women, and men with high central adiposity (body fat). You will need to observe your training loads.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

• The pain may get worse when you use the tendon.
• You may have more pain and stiffness during the night or when you get up in the morning.
• The area may be tender, red, warm, or swollen if there is inflammation.
• You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be similar or combined with bursitis.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist or doctor will ask questions about your past health, symptoms, and new exercise regime. They’ll undertake a thorough physical examination to confirm the diagnosis. They will then discuss your condition and devise an individualised treatment plan.

They may refer you for specific diagnostic tests, such as an ultrasound scan or MRI.

Tendinopathy Treatment

Tendinopathies can typically rehabilitate quickly and effectively. However, there is a percentage of tendinopathies that can take months to treat effectively.

As mentioned earlier in this article, it is essential to know what phase your tendinopathy currently is. Your physiotherapist can assist not only in your diagnosis but also guide your treatment to fast-track your recovery.

Before you seek the advice of your physiotherapist or doctor, you can start treating an acute tendon injury at home. To achieve the best results, start these steps right away:

• Rest the painful area, and avoid any activity that makes the pain worse.
• Apply ice or cold packs for 20 minutes at a time, as often as two times an hour, for the first 72 hours. Keep using ice as long as it helps.
• Do gentle range-of-motion exercises and stretching to prevent stiffness.

When to Return to Sport

Every tendinopathy is different, so please be guided by your physiotherapist assessment. Be patient, and stick with the treatment exercises and load doses prescribed by your physiotherapist. If you start using the injured tendon too soon, it can lead to more damage and set you back weeks! It may take weeks or months for some tendon injury to heal and safely cope with a return to sporting loads.

Tendinopathy Prevention

To minimise reinjuring your tendon, you may require some long-term changes to your exercise activities. Please discuss this with your physiotherapist. Some factors that could influence your tendinopathy risk include:

• Altering your sport/activities or your technique
• Regular prevention exercises.
• Closely monitoring and record your exercise loads. Discuss your loading with your physiotherapist and coach. They will have some excellent tips.
• Always take time to warm up before and cool down / stretch after you exercise.

Tendinopathy Prognosis

While most acute tendinopathies can resolve quickly, persisting tendon injuries may take many months to resolve. Long-term or repeat tendinopathies usually have multifactorial causes. These require a thorough assessment and individualised rehabilitation plan. Researchers have found that tendon injuries respond differently to muscle injuries and can take months to solve or potentially render you vulnerable to tendon ruptures, which can require surgery.

Please seek the advice of your trusted tendinopathy healthcare professional.

Related Articles

• Common Tendinopathies: An Overview of Tendon Injuries – Insight into various tendinopathies and their treatment.
• Proximal Hamstring Tendinopathy – Focuses on high hamstring tendinopathy and its implications.
• Rotator Cuff Tendinopathy – Detailed information on rotator cuff tendinopathy.
• Gluteal Tendinopathy – Discusses the causes, symptoms, and treatments for hip tendinitis.
• Achilles Tendinopathy – A comprehensive guide on Achilles tendinopathy.
• Patellar Tendinopathy – Information on the causes and management of jumper’s knee.
• Wrist Tendinopathy – A common cause of wrist and forearm pain.
• Why Rest Isn’t Good When it Comes to Tendons