Tendinopathy is a general term used to describe an overuse injury of a tendon characterised by a combination of symptoms including pain, swelling, and stiffness. This can ultimately affect a person’s ability to undertake physical activity and can be debilitating with daily activities.
Tendons are tough fibres, much like a rope, that connect muscle to bone and are organised in a specific way to provide strength and enable them to adapt to load. The understanding of why tendons change in structure and become painful has changed over the past decade, and we now consider the underlying problem to be a degenerative process (although there is thought to be some inflammation in the early stages).
Tendinopathy can affect all age groups and levels of physically active people. Too much load (known as an ‘abusive load’) through the tendon is primarily the causative factor, but there is a large variation in how much load individuals can endure before developing symptoms. It is recognised that less active people can also suffer from tendinopathy.
Generally, the incidence increases with age, as the load threshold required to affect the tendon decreases. However, there are certain factors that can contribute to the development of tendinopathy, including any sudden change in the volume or intensity of physical activities, training errors and lack of general physical conditioning, including biomechanical issues. In addition, tendon problems can be associated with medical problems such as diabetes, high cholesterol levels, certain rheumatological conditions and prescribed medications.
Tendinopathy is predominately caused by repetitive activities to the muscle tendon unit and is a result of a failed healing response of the tendon. The strain on the tendon causes micro-tears that can build up over time.
A tendon injury may appear to happen suddenly, but usually is the result of structural changes in the tendon that have developed over many months or years (so-called the degenerative process). Often the more ‘acute’ symptoms of pain and swelling are the result of an excessive load being suddenly applied to the tendon e.g.- hill running, jumping activities.
Tendinopathy causes pain, localised swelling, weakness and often restricted movements of the associated joint. The pain may be worse when you use the tendon and stiff when you first get up in the morning. As symptoms, progress the tendon can be painful with normal activities of daily life.
The relatively new understanding of the underlying causes of tendon problems has resulted in new and novel treatment options.
In our Sports Medicine clinic, we manage both upper limb and lower limb tendon problems. At your first consultation, we discuss how your symptoms started and whether there were any changes to physical activities prior to the onset of your symptoms. We evaluate whether you have any risk factors for tendon problems and often use symptom questionnaires to assess the severity.
A full clinical examination is performed, looking at not only the affected tendon, but surrounding muscles and joints that may contribute to ongoing problems. We often work with Consultant Orthotists for a biomechanical assessment of the lower limb.
An ultrasound is often recommended as this helps to evaluate the structural changes and guide our management options.
The management of tendinopathy depends on the level of the tendon changes and how long you have had the symptoms. The primary treatment approach is known as ‘load management’, which essentially means an individualised physiotherapy programme whereby the tendon is gradually loaded to facilitate adaptation, healing and strength.
If symptoms are reported relatively early, often only a short period of physiotherapy rehabilitation is required. However, with more chronic long-standing symptoms, it can take several months for the tendon to fully recover.
As the basic science of tendinopathy has evolved, so have the treatment options for these conditions.
In acute cases, we may recommend the use of nonsteroidal anti-inflammatory medication, such as ibuprofen or similar medication. But this has only been found to be beneficial in the early stages of tendinopathy when used for seven to 10 days. There is research to suggest that long term use of these medications can be detrimental to the tendon healing process.
Adjunct treatment modalities offered also include extra-corporeal shock wave therapy (acoustic waves) which helps to stimulate the tendon structure to facilitate repair processes by several different mechanisms.
Injection therapies are also used in some cases and these include high volume injections, sclerosants or platelet rich plasma (blood) with additional dry needling to the tendon. Corticosteroid injections into the tendon are no longer thought to be effective long term and can be detrimental to the tendon structure.
Following your initial appointment, we will discuss your treatment plan with you and monitor your progress over the following months. We work closely with our physiotherapy team to ensure we can return you to your physical activities safely.