Tendons are remarkable structures which connect muscles to bones. They are made up of connective tissue that transmits tensile force generated from the muscle to the bone resulting in movement. Along with this, tendons act like a spring by storing energy and increasing force production. Seems simple right?
Unfortunately, tendinopathy (tendon pain) is a relatively common and often problematic issue. The main cause of tendinopathy happens when the amount of load placed on the tendon is higher than what it is used to.
Signs that you may have a tendinopathy:
- very localised pain in the tendon
- aggravated by heavier loading eg running more sore than cycling
- pain/stiffness in the morning and/or day after exercise
- the tendon may be thicker and quite tender to touch
The most common tendinopathies include the achilles, patella (knee), lateral hip, elbow and shoulder.
Risk Factors:
The main risk factor in developing a tendinopathy is a sudden change in the load demand of that tendon. Other risk factors include poor muscle strength/endurance, decreased range of motion, increased age, high cholesterol levels and hormonal changes such as post-menopausal women.
Some tendinopathy truths:
- Tendinopathy is not caused by inflammation. Even though the tendon may be swollen this is a normal part of tendinopathy. Anti-inflammatories and icing may reduce pain if it is severe but it won’t improve the function of the tendon
- Rest does not fix a tendinopathy. Stopping exercise may settle the pain, however the tendon will flare up again once you return to activity as it will not improve the tendon’s capacity to take load.
- You should not push through the pain. The loads being placed on your tendon need to initially be modified to let it settle. Then it can be gradually re-loaded. Pushing through pain will only make it worse.
- The problem is not only in the tendon itself. Many tendon issues are caused by multiple risk factors including sub-optimal strength and range of motion in other areas in the mechanical chain.
- Tendons may not respond well to steroid injections. Steroids can result in increased breakdown of the structure of the tendon, resulting in a reduced capacity to transmit force.
- Sore tendons do not like to be stretched. This can cause compressive forces to be exerted on the tendon which will not help it to settle.
How to treat tendinopathy:
Exercise is the most evidence-based treatment for this condition. Passive treatments can help manage pain short term but will not resolve the issue in isolation. All tendinopathies are unique and therefore must be specifically assessed and individually treated. Initially the key is to settle the pain though load modification (not complete rest). Once this is done, a comprehensive rehabilitation program is needed to restore the tendon to optimal function. The timeline for this varies but can often last for 3-4 months. Tendons may quickly become sore with too much loading, but they respond very slowly to a rehab program. The key factors for a successful outcome are consistency, gradual progression and patience. There is emerging evidence that shockwave can be beneficial for those more stubborn tendons that aren’t quite fully responding. Shockwave is also an option for managing tendon pain in the sporting season when a comprehensive rehab program is not as easy to implement.
Should I get a scan?
People often come to physio with a scan showing tears/degeneration in their tendon. However we know that these changes can occur in people who have full function and no pain. We also know that improving people with tendinopathy will not necessarily improve the quality of their scans. Therefore scans are usually not recommended in people with tendinopathy.
Should you wish to see a physiotherapist to assist with your tendon pain, feel free to contact us on 03 9421 1626 or alternatively book online via our website here.
Author: Wendell Vagg, Physiotherapist