Tendinopathy: what does it mean and what do I do about it?
You may have heard about or experienced an injury that you have been told is a tendinopathy, tendonitis or tendinosis. These terms are essentially just other names used for the same thing. A tendinopathy is a generic term that is used to describe a tendon when it has been overloaded or overused which has led to persistent pain, reduced function and exercise intolerance.
Where are the most common areas for tendinopathies to occur?
High hamstring: this is where you might feel persistent pain on your “sit bones” or just below your bum, these are your ischial tuberosities where your hamstrings tendons attach.
Achilles tendon: this is the large tendon that attaches your calf muscle to your calcaneus (heel bone), people may get pain at different sections of their Achilles tendon which may result in slightly different types of tendinopathy diagnosis.
Tennis elbow: this occurs at the lateral aspect of the elbow, the common tendon attachment for the wrist extensor muscles on the back or the hairy side of your forearm. More specifically the Extensor Carpi Radialis Brevis tendon. The name originates from tennis players performing a backhand stroke with the racket causing overuse of the wrist extensor muscles, but this injury is also very common in any profession that requires using the hands and forearms. It can affect office workers, construction workers, new parents, gym goers and elite athletes.
Golfers elbow: this one occurs on the inside of the elbow and is the common tendon for the wrist flexor muscles, again it is named after the sport due to the movement pattern in golf but this injury can occur in anyone similar to tennis elbow.
Patella tendon: this has also been referred to as “jumpers knee” due to it being a common injury in people participating in sports and activities that require a lot of jumping and landing, such as basketball and volleyball. However anyone can develop patella tendinopathy.
Gluteal tendinopathy: outside of the hip.
Rotator cuff: this one may feel slightly different to other tendinopathy’s and may be more difficult to diagnose due to the complexity of the shoulder.
What are the symptoms and what does it feel like?
Generally a tendinopathy will have quite clear symptoms including the ones listed below, this is usually coupled with some increase in activity or load prior to the pain starting.
Pain when using them/the muscle that is connected to the tendon.
Quite often they will feel better once warmed up and have used them
They will feel stiff and sore in the morning or after long periods where you haven’t moved the involved/affected area.
Pain on palpation (touch) of the tendon involved
The pain may begin as feeling more intense but then over time start to feel like a dull specific ache in the area.
Why does it happen?
The concept as to why we develop tendinopathies has to do with load vs capacity. Our tendons are designed to adapt to load, if we start to increase the load in a tendon, it should be able to adapt to that load and become a little bit stronger. Increasing load bit by bit in small increments allows the tendon to adapt and slowly build up a higher capacity meaning we can then apply more load.
However, sometimes we can either load the tendon too soon without giving it time to adapt and recover or we can simply apply too much load in one go. This can cause the tendon to weaken as we are applying too much load for what it can handle.
In general, research shows that a tendon can take between 48-72 hours to adapt but this may vary depending on specific factors. For example, age has an impact, the older we are the less adaptable our tendons are which would suggest we need to manage load increases more carefully. The amount of exposure our tendons have had to load over time, a person who has participated in a lot of sport or activities that have stressed the tendons may find it easier to adapt than someone who has been inactive or sedentary.
When we talk about load this can be in the form of weights or strength training, running, team sports and even everyday repetitive activities. We can prepare the body for specific activities by increasing the capacity of a tendon through strength training and specific exercises.
How do I manage a tendinopathy?
There are a lot of people who end up with chronic tendinopathies due to not gradually increasing the load. An example of this is someone starting a new activity and trying to do too much too fast, they then end up with tendon pain so they rest, then the pain subsides and they repeat the process of too much load too quickly and end up stuck in a never ending cycle.
Initially, you would want to offload the tendon enough to reduce symptoms but not unload it completely. This may take a little trial and error and paying extra attention to symptoms to see what aggravates it the most, this includes being aware of activities you may have done the previous day if your tendon pain is worse on a morning.
Unloading the tendon can also apply to everyday activities that may increase aggravation, things such as hamstring tendinopathy being made worse by sitting on hard chairs that compress the tendon or by bending forwards applying too much stretch, sleeping on your side with gluteal or rotator cuff tendinopathy causing compression, Achilles tendinopathy can also be aggravated by putting the calf on too much stretch, for example, leaning forward when standing, tucking feet underneath your chair at work.
If you have been unable to load a tendon due to pain for a long period of time this may have also had an effect on the attaching muscle, the muscle itself may have become weakened due to being unable to load it because of the tendon pain. The most important thing in tendon rehabilitation is managing load and pain. while it is okay for there to be some discomfort during an exercise it shouldn’t make the pain worse in the 24 hours following.
Load must be gradually increased, slowly adding progressions, this might start with isometric exercises so adding some load to the tendon but without any movement, then progressing to some weighted movements. The higher the intensity of the “end goal” activity the higher the intensity of the rehab process. For example, if someone just wants to get back to walking and going up and down stairs pain free the rehab will be less than someone who wants to return to sport.
It is important to remember to be patient and that everyone is different and different people will recover and improve at a different rate due to numerous factors including severity, lifestyle, activity level, age, health, goals etc.
What can Muscle Therapy do for you if you have a tendinopathy or a suspected tendinopathy?
- We can assess the area and see whether we believe there is a tendon issue
- We can assist you in finding out what are your most aggravating activities as well as where the issue may have started
- While treatment alone will not “fix” the tendinopathy we can help reduce symptoms, pain and facilitate healing within the area which will make your journey to recovery a lot more manageable
- We can help prescribe specific exercises to guide you on your rehab journey
- All forms of treatment we offer can help with your pain and discomfort, since tendons do not respond well to stretching it would be difficult to reduce the tension that will have built up in the adjoining muscles. For example, the Achilles tendon attaches the calf muscle to the heel so for an Achilles tendinopathy we can release the calf muscles to take the stretch/pressure off the tendon itself.
- From here we can assist in your overall ongoing recovery and help keep the rest of your body in check while you progress towards your goals, whether they be specific to sports and fitness related or just being able to go about your day pain free.
If you want more information about the different treatments we offer you can find more detail about each of the techniques we use on our website..
This is general advice and information. Each case is different when it comes to a tendinitis injury. The first step is figuring out what is going so getting an assesmsnet and treatment is very important. Please book in to have your issue looked at by one of our amazing therapissts.
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