A tendon is a piece of fibrous tissue that joins muscles to bone. The most well-known tendon is the Achilles tendon, which connects the calf muscle to the foot. Tendinopathy is a term used to describe tendon pain or dysfunction. In the health profession, there are many other terms used to describe this condition, including tendonitis, tendinosis, paratendinitis, tenosynovitis and enthesopathy.
Tendinopathy can occur in any tendon in the body and can occur mid-tendon, at the bony insertion (where it attaches to bone) or at the musculotendinous junction (where the tendon originates on the muscle).
Tendon tissue strength develops in response to a healthy amount of loading (use). When a tendon is exposed to load, the tendon adapts to that load. However, tendinopathy occurs when a tendon is unable to adapt to the load that it is being given, which is why tendinopathy is referred to as an ‘overuse’ injury. This can result in pain, tissue changes and eventually tear or rupture. There are 3 stages to a tendinopathy.
1. Reactive Tendinopathy
- Normal tissue adaptation phase in response to acute overload
- Prognosis: Excellent with simple activity modifications to reduce overload
2. Tendon Dysrepair
- Tendon is overloaded. Repair rate is unable to keep up with injury rate.
- Morphological changes to tissue occur
- Prognosis: Variable
3. Degenerative Tendinopathy
- Cell death occurs
- Prognosis: Poor
Image source: Pathogenesis and management of tendinopathies in sports medicine (Translational Sports Medicine, 2017)
Signs & Symptoms
- Pain after exercise or the morning after exercise
- Pain-free at rest and initially more pain with use
- Pain worse at beginning of exercise that reduces after warming up, but returns after cooling down
- Increasing stiffness
Prognosis
Prognosis of tendinopathies can vary significantly based on numerous factors, including: stage of the disorder, age, activity levels and how long you’ve had symptoms.
For tendons at the reactive or early dysrepair stage, with simple activity modification it may recover within 1-2 weeks.
However, for tendons in late dysrepair or the degenerative stage, it can take much longer. A progressive tendon rehabilitation program will need to be implemented in this case which will need to be monitored and progressed by your physiotherapist.
Management
Typically, management of tendinopathy will include modifying the amount, or the types of activity to reduce the load going through the tendon, which should help to reduce pain in the short term. However, to facilitate recovery of this type of injury, the tendon needs to have sufficient load, which means exercising is critical to the recovery process.
So how much, and what type of exercise should you do?
Your physiotherapist will guide you as to what exercises are appropriate for you. Initially this is likely to be isometric exercises (contracting the muscle without moving the joint) and be progressively increased as pain reduces, or strength increases.
The amount of exercise will depend on the amount of pain you experience. Generally, the amount and duration of pain you experience is used as a guide. You should never experience severe or long-lasting pain when doing your exercises. If you do, it means you are doing too much.
