Tendons and Tendinopathy
By David Gibson
Tendinopathy, also known as ‘tendinitis’, is one of the most common issues that physiotherapists deal with in clinic. Recent developments in Sports Injury research is teaching us that Tendinopathy is not an inflammatory process as once thought, rather it is pain resulting from structural changes within a tendon in response to LOADING.
Most commonly affected tendons include the Achilles tendon (ankle), Patellar tendon (knee), Gluteal tendons (Hip) and Rotator cuff tendons (Shoulder). The purpose if this series of blogs is to examine each of these injuries, debunk some Myths and provide the most up to date guidance on how to manage each one.
What is a Tendon?
- Tendons connect muscle to bone and transmit forces from our muscles to create movement of our skeleton.
- Tendons can act like SPRINGS. They can absorb force when put on stretch to allow a recoil and resulting force – The Achilles is a great example of this when running.
- Pain and Injury can result from an increase in loading to our tendons
Symptoms of Tendinopathy
Key symptoms are a deep dull ache over the tendon, usually Following Activity. A fluctuation pain pattern but often worse in the evening and first thing in the morning. Usually coincides with an increase in activity but not always.
Each separate tendon condition presents differently- full details can be found in the individual blogs found in the blog section of www.balancededinburgh.co.uk
What Causes Tendinopathy?
Some risk factors we have no control over: 
- Age – Most prevalent after the age of 40 as our tendons become less able to repair themselves, leading to disrepair and injury
- Genetics – Some research has established links between some genes and tendinopathy. It could be that you are more likely to have tendon pain if others in your family suffer from it.
- Body Allignment – Also known as ‘Biomechanics’. Some researchers have shown links between certain body shapes and the incidence of tendon injuries.
However the MOST IMPORTANT factors are within our control….
- ACTIVITY – Doing too much walking, running, jumping, or repetitive arm use all increase loading to our tendons and leave them vulnerable to injury.
- Obesity –
Increase body weight = Increased loading on tendons
- Elevated Cholesterol – Aerobic exercise, Diet and medications can all play a part in management of Tendinopathy
- Hormones – Women are more susceptible around Menopause, most likely due to reduced estrogen levels at this time. See blog on ‘Gluteal Tendinopthy’ with links to some interesting research on this topic.
- Muscle Weakness – Muscles need to be strong to support our tendons and keep them in the right alignment. Muscle weakness has been shown to increase tendon loading and the likelihood of injury.
- Biomechanics – Best described as our alignment- the co-ordination of our muscles and body shape play an important role in distributing forces through our body.
Should I be concerned if I have a Tendinopathy?
In the vast majority of cases…. NO!
- Pathology in a tendon is common in people who have no pain and function at a really high level!
- Even with a severe pathology, your pain cam improve with the right management.
- Painful tendons HARDLY EVER tear suddenly – the fact a tendinopathy increases your risk of a rupture is a myth.
What should I do?
- LOAD MANAGEMENT – Initially you will need to reduce activities that cause pain such as running, jumping, walking too far etc. Then you will GRADUALLY increase these activities as you load tolerance improves. An exercise diary or an app that measures steps can be really useful in the early stages to work out your baseline.
- AVOID AGGRAVATING POSITIONS – In particular, tendons do not like to be compressed. Adapting sitting, standing and sleeping positions can make a real difference to your pain.
- DON’T STRETCH – Despite common practice, Stretching does not help tendinopathy! Research suggests that loading the tendon (ie STRENGTHENING) is far more effective for a long-term outcome
- PHYSIOTHERAPY EXERCISES – ok, I might be biased but progressively loading your tendon is the Key to success!!
- Pain management strategies can also be beneficial in the short term – ie NSAIDs (always on Drs advice), Ice/Heat and foam rolling for self massage. However, these components are unlikely to affect the long term outcome of your condition.
https://www.tendinopathyrehab.com/
Is pain normal after exercise?
Yes, some pain is normal post exercise. A good rule of Thumb is that pain should not exceed 4/10 and should have settled within 24 hours. Some background pain is also normal with tendinopathy- Speak to your Physiotherapist regarding what would be considered a normal level for you.
Other factors that can help
- General exercises that don’t provoke symptoms are recommended. ‘Cross training’ by cycling or swimming is often indicated
- Managing stress. It is no surprise that a lot of people present to the Physio clinic at a time of increase work, family or emotional stress. My colleague, Ellen, has written an excellent blog on stress management. This can be found in the blog section at www.balancededinburgh.co.uk
- Sleep. There is growing evidence across the sports injury world that improving sleep can have positive effects on physical health.