What is a tendon?
Tendons are the tough fibres that connect a muscle to the bone. Injuries to tendons normally occur close to joints such as the shoulder, elbow, knee or ankle. Healthcare professionals may use the terms tendinitis or tendinosis to describe tendon injuries.
TENDINITIS describes the typical healing process of the tendon and is a valuable, normal inflammatory response that the body provides to deal with injury. This can quickly heal if managed appropriately. The real problems occur when this healing process is slower than the injury rate. In other words, microscopic tears in the tendon are not allowed to heal before more tears occur. This can lead to changes within the tendons’ structure at a cellular level and the tendon can become degenerative. This is often described as TENDINOSIS, or a TENDINOPATHY. When a tendon reaches this stage, the best outcomes are achieved with early intervention via Physiotherapy.
What causes a tendon injury?
Tendon injuries can be caused by many different factors, but the main one being a sudden change in certain activities. This may include starting a new sport, changing your training routine or even something as subtle as wearing a new pair of shoes/trainers. This is because the tendon becomes more stressed than usual and responds with the inflammatory process described above. Some people are more prone to tendon injuries because of their biomechanics or lifestyle factors such as age, cholesterol levels or medical conditions. Your Physiotherapist will be able to take a detailed history of all these factors to determine what the likely cause of your pain is.
What should I do with my tendon pain?
If you have had your pain for one week or less, you may have a tendinitis. This can respond quickly to appropriate anti-inflammatory medication advised by your GP, and “relative rest”. This means that you adapt the activity that is causing your symptoms, to allow your tendon to heal. Your Physiotherapist can guide you on exactly what to do to achieve this.
If your tendon pain seems more persistent than this or is a recurrent problem, you may have a tendinopathy. This usually presents with a small thickening of the tendon that you might be able to feel when gently rubbing your tendon.
How can I manage a tendinopathy?
1. Tendinopathy does not improve with rest
The pain may settle, but returning to your normal activities will often cause the symptoms to reoccur.
2. At this stage, anti-inflammatory medication has little effect
Your symptoms may be eased slightly with anti-inflammatories, but there is very little evidence to suggest that this has an effect on the tissues that are producing the pain.
3. Exercise is the most evidence-based treatment
Tendinopathies need to be loaded progressively with specific exercises that your Physiotherapist can guide you on. This enables development of greater resilience to the stressful load that the tendon is experiencing.
4. The stressful stimulus to the tendon must be modified to achieve the best outcome
This is where your Physiotherapist’s detailed history of your daily activities will be invaluable in determining the cause for pain. From this, they will be able to tell you exactly what to modify or avoid allowing relative rest for the tendon.
5. Ultrasound scan findings are not relevant to prognosis or pain levels
It is very common for people without any pain to have irregular findings on scans. Also, if you have been told you have “severe thickening” or “large tears”, this DOES NOT mean you will not get better, or have a poorer outcome.
6. Tendinopathies will very rarely improve without specific exercises
Passive treatments such as massage, injections, ultrasound or shockwave therapy are not adequate to treat a tendinopathy on their own. Your Physiotherapist may use other techniques to complement the exercises, but exercise is the vital ingredient!
7. The exercises must be individualised
This is again based upon your Physiotherapists subjective examination. Pain, function and normal daily activities should all be considered to allow the tendon to progressively manage more load, and achieve the outcomes you desire.
8. A tendinopathy responds very slowly, even with the correct treatment
There needs to be a certain amount of patience and perseverance involved when carrying out these exercises. You are very unlikely to see changes from day-to-day, but week-to-week and month-to-month you will likely notice significant improvement in your pain and function with Physiotherapy treatment. Try to avoid the often labelled “short-cut” options of surgery and repeated injections, as these have much poorer outcomes when compared to Physiotherapy.
In summary, due to their poor blood supply, tendons are stubborn and can easily become a more chronic irritable condition. However, with the appropriate Physiotherapy treatment, you can return to full and pain free activities.