Tendonitis Tendon Injury Sports Injury

Tendinopathy

A tendon is a band of tough, fibrous connective tissue which attaches a muscle to a bone. Tendinopathy is the clinical term used to describe pain or pathology in a tendon. Traditionally, tendons have been thought to have a poor blood supply and therefore slow healing rates, however recent studies have shown this not to be the case, rather showing an adequate blood supply for its demands. Tendons have two main roles - to transfer load and to store and release energy in order to allow adequate function.

 

Typical Tendon Pain

 

  • Localised pain with weight-bearing

  • Localised tenderness with palpation

  • Clear relationship between loading and pain.

  • Tends to warm up with activity.

  • Flares up when loads change (particularly over a short period of time)

 

Commonly Injured Tendons

 

There are many tendons throughout our body which are commonly injured, examples include: Achilles, gluteal tendons, hamstrings, patellar/quadriceps, tibialis anterior/posterior, plantar fascia, rotator cuff (shoulder), biceps, triceps, forearm flexors/extensors.

Causes

 

Rapid changes in activity/training loads, poor or altered biomechanics, poor exercise technique or form, activities such as walking, running, jumping, throwing, repetitive overhead lifts, metabolic conditions such as diabetes can contribute to symptoms, slower healing rates and other psychosocial aspects such as past experiences, stress & anxiety, chronicity, interpretations of pain

 

What happens to the tendon and why is it painful?

 

The most common mechanism of tendon injury is usually associated with a fast stretch-shortening cycle (SSC) often with activities such as walking, running, jumping, throwing and repetitive overhead activities. Put simply, it usually starts with poor functional control of the muscle attached to the tendon, which then leads to pathological change within or around the tendon and surrounding structures. When a tendon becomes irritated, it undergoes cellular changes resulting in disorganised and poorer quality of tendon tissue and potentially irritation of surrounding structures, increased nerve and blood vessel ingrowth and calcification.

Treatment

 

There are a wide range of treatment techniques available at our clinic to manage tendinopathy. Traditionally tendon injuries have been managed with rest and ice, however new and current research has shown us that the most important thing to do is LOAD the tendon in a progressive and controlled way in order to stimulate tendon adaptation and positive cell changes. To do this we have to establish what we call LOAD TOLERANCE, essentially a point in which the exercise you do causes pain that you are happy to put up with. It is vital to remember that PAIN DOES NOT EQUAL HARM OR TISSUE DAMAGE - it just means we are beginning to positively adapt the tendon. Your practitioner will take you through SLOW, HIGH LOAD exercises that research shows to be the best way to adapt and  reduce painful symptoms in the affected tendon.

 

There are many concurrent treatment strategies we can use together with our tailored rehab program including:

 

  • Biomechanical screening assessment

  • Radial Shockwave Therapy (rSWT)

  • Dry Needling/Western Acupuncture

  • Manual therapy (massage, mobilisation)

  • Orthotics or other corrective devices

  • Taping/Bracing

  • Tailored additional rehab for specific needs (eg: sport or work specific rehab)

  • Education on condition and activity modification