Tendinopathy

Tendinopathy

Article by J.Miller, Z.Russell

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.

Physiotherapist-in-navy-polo-shirt-treating-patient-for-tendinopathy-injury-in-clinic
Physio Treatment Assisting Tendon Recovery

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

Tendinopathies affect individuals across various age groups and physical activities, and these prevalent musculoskeletal conditions cause pain and impaired function, significantly impacting the quality of life. Active individuals, including athletes and those engaged in repetitive occupational tasks, are particularly susceptible to these overuse injuries.

This article aims to provide a comprehensive overview of common tendinopathies, focusing on their specific manifestations and management approaches. By exploring the intricate details of conditions ranging from Achilles Tendinopathy to de Quervain's Tenosynovitis, we aim to enhance understanding and promote effective treatment strategies for those affected.

Tendinitis vs Tendinopathy

It's important to note that "tendinitis" is often used interchangeably with tendinopathy, but the suffix "-itis" implies inflammation, which is not always present in tendinopathies. In many cases, the condition involves degeneration of the tendon rather than acute inflammation. As a result, the more accurate term used nowadays is "tendinopathy."

Tendinopathy Treatments

Treatment approaches for tendinopathies typically focus on managing pain, promoting healing, and addressing contributing factors (e.g., overuse, improper biomechanics). Additionally, treatment approaches have advanced to include more targeted therapies, such as eccentric exercises, physiotherapy, and sometimes regenerative medicine techniques, depending on the specific type and severity of the tendinopathy.

Tendinopathy Classifications

Tendinopathy classifications have evolved to encompass a more nuanced understanding of these conditions. The modern tendinopathy classifications now include the following:

  1. Tendinitis or Tendonitis is an acute tendon inflammation, usually resulting from overuse, injury, or repetitive strain. It involves the active inflammatory process, and the symptoms can include pain, swelling, and limited range of motion.
  2. Tendinosis is a chronic degenerative condition of the tendon that occurs when repetitive micro-injuries do not have sufficient time to heal and repair properly. Unlike tendinitis, tendinosis does not primarily involve active inflammation. Instead, it is associated with a breakdown of collagen fibres within the tendon, leading to its structure and composition changes.
  3. Paratendonitis and Tenosynovitis: These conditions involve inflammation or irritation of the paratendon (the outer layer of the tendon) or the tenosynovium (the sheath surrounding certain tendons). Paratendonitis and tenosynovitis can lead to pain and limited function of the affected tendon and are often associated with repetitive motions or friction.
  4. Insertional Tendinopathy: This type of tendinopathy occurs at the point where the tendon attaches to the bone (the insertion site). It can involve inflammation, degeneration, or a combination of both at the tendon-bone interface.
  5. Mid-Substance Tendinopathy: Mid-substance tendinopathy refers to conditions affecting the central portion of the tendon rather than the attachment points. This tendinopathy is often related to chronic overuse and may involve changes in the tendon's structure without significant inflammation.

It's important to note that the classification and understanding of tendinopathies continue to evolve with ongoing research. If you suspect you have tendinopathy, it's best to seek evaluation and advice from a healthcare professional, such as your physiotherapist, who is experienced in tendon conditions.

Seeking Professional Advice

Consult a physiotherapist with a special interest in tendinopathies for personalised advice and treatment.

Specific Tendinopathies

Foot & Ankle

Knee

Hip & Groin

Shoulder

Elbow

Wrist & Hand

Conclusion

Tendinopathy is a complex condition requiring careful diagnosis, treatment, and management. Understanding its phases, symptoms, and treatment options is vital for effective recovery.

What to Do?

If you suspect tendinopathy, consult a physiotherapist for a thorough assessment and tailored treatment plan. Remember, early intervention can significantly improve your prognosis and hasten recovery.

Related Articles

  1. Tendinopathy: Causes, Symptoms, And Effective Treatments - Discover a broad overview of tendinopathies, including causes, symptoms, and a variety of effective treatment options​​.
  2. Effective Tendinopathy Physiotherapy Treatment Strategies - Explore advanced physiotherapy treatment strategies for managing tendinopathies effectively​​.
  3. Biceps Tendinopathy: Causes, Symptoms, And Treatments - Gain insights into the specific causes, symptoms, and treatment options for biceps tendinopathy​​.
  4. Gluteal Tendinopathy: Causes, Symptoms, And Treatment - Learn about gluteal tendinopathy, its impact, causes, symptoms, and how it can be treated​​.
  5. Rotator Cuff Tendinopathy - Understand the specifics of rotator cuff tendinopathy, including its causes, symptoms, and various treatment methods​​.
  6. Proximal Hamstring Tendinopathy - Find detailed information on proximal hamstring tendinopathy, including prevention and treatment strategies​​.
  7. Peroneal Tendinopathy - We discuss the causes, symptoms, and rehabilitation processes for peroneal tendinopathy, and how to return to sports safely​​.
  8. Wrist Tendinopathy - Uncover the range of treatment options for wrist tendinopathy, from early injury treatment to physiotherapy modalities​​.
  9. Hip Adductor Tendinopathy - Effective Physio Solutions - Explore the causes, symptoms, and physiotherapy solutions for hip adductor tendinopathy​​.
You've just added this product to the cart: