What is it?
Tendinopathy is the modern term for injuries you may have heard of such as tendinitis or tendinosis. It is an encompassing term for these conditions and is generally the way these conditions are referred to now. This pathology can happen in any tendon in the body, however, there are a few common ones you may know of such as tennis elbow, golfer’s elbow, jumper’s knee and Achilles tendinitis.
Often described as overuse injuries, tendons generally don’t respond well to sudden changes in load, such as doubling the amount of running or walking you are doing in a week, or taking on a new job where you must type for 8 hours a day when your elbow tendons are not used to this. Combined with inadequate rest and poor nutrition these could be a recipe for disaster. If there is a gradual increase in the activity over a period of weeks to months, the connective tissues that make up your tendons have the time they need to adapt so they can withstand the forces you are putting them through. In summary, if you take the time to build up to it, you may be able to tolerate high volumes of a particular activity quite well. If you jump straight into it, you may find yourself with one of these pesky tendon injuries.
Signs and Symptoms
Localised tenderness over the tendon.
Warm up phenomenon – what this means is you may feel quite stiff and sore in the first few minutes of exercise or movement but the pain tends to decline as you warm up.
24hr response – you will often feel good while exercising but then will pay for it the next morning with increased stiffness and pain. Tendinopathies have a latency to their pain response and as a result, you need to be aware of what you were doing yesterday to relate it to how your pain feels today.
Relationship to load – pain will magnify with increased speed or weight, however, the pain generally stays in the same spot.
Management
Tendinopathies respond quite well to conservative, non-operative management. We would help you to identify key spikes in load on the tendon and discuss ways to mitigate this. Sometimes this can be difficult when a work task is a major cause of the tendinopathy but there are usually measures you can put in place to offload the tendon.
Step one is identifying and mitigating the offending load. Once this has been addressed, the next step is to build a more robust tendon through strengthening exercises. If your pain levels are quite high this would start with isometric exercises (static holds), which have been shown in some tendons to be quite effective at decreasing pain. When your pain drops to an acceptable level we would begin an isotonic program of either eccentric exercise, where you only do the ‘lowering’ phase of a movement against resistance, or a heavy loading program in the gym, depending on the individual and depending on the tendon affected. An eccentric or heavy-loading program in the gym may take around 12 weeks to complete.
In the latter stages of tendon rehabilitation, some exercises that stress the tendon in more advanced ways and look more like the offending load would be introduced. This could be things like running, jumping, or hopping for lower limb tendons, and for upper limb tendons this could look like pullups, pushups or tennis rallies on a half court, depending on the tendon.
Lastly, we would guide you through returning to sport (if that is your goal), by first joining in with training, and then if you play a competitive sport you may begin with quarter games, then half games, then return to full play.
Alternate treatments
Sometimes exercise therapy is not enough for a tendon. Often this is if they have been left to build up over a long period of time and there is quite a large degree of degeneration in the tissues. If the tendon is not responding as we would expect, often we may advise you to seek the opinion of a sports and exercise physician. Alternative therapies include extracorporeal shockwave therapy, PRP injections and prolotherapy and are usually used in conjunction with exercise for the best results.