Understanding Tendinopathy: When Tendons Act Up

Aug 29

Have you ever felt a persistent ache or stiffness in a joint, especially after activity, that just won't seem to go away? It might not be a muscle strain or a joint issue, but rather a problem with your tendons. This condition is often referred to as tendinopathy.

Tendinopathy is a common issue, particularly among athletes, manual laborers, and anyone engaging in repetitive movements. It's a broad term that encompasses pain, swelling, and impaired function in a tendon, resulting from overuse or repetitive stress. Unlike "tendinitis," which implies inflammation, "tendinopathy" is a more accurate term as current research suggests that chronic tendon pain often involves degeneration of the tendon tissue, not just inflammation.

Let's explore what tendinopathy is, its common causes, how it manifests, and how it can be effectively managed.

What is Tendinopathy?

A tendon is a strong, fibrous cord of connective tissue that connects muscle to bone. Tendons transmit the force generated by muscles to move bones, allowing for movement and stability around joints.

Tendinopathy occurs when a tendon is repeatedly overloaded or overused, leading to microscopic tears and changes in the tendon's structure. Over time, the tendon tissue can become disorganized and degenerated, leading to pain and weakness. It's a spectrum, ranging from reactive tendinopathy (an acute response to overload) to degenerative tendinopathy (a more chronic condition with structural changes).

Common Causes of Tendinopathy

Tendinopathy typically develops due to a combination of factors, including:

Overuse or Repetitive Strain: This is the most significant factor. Repeated movements or sustained loads on a tendon, without adequate rest or recovery, can lead to micro-trauma.
Sudden Increase in Activity: A rapid increase in the intensity, duration, or frequency of an activity that the tendon isn't conditioned for.
Poor Biomechanics or Technique: Incorrect form during sports, exercise, or work tasks can place abnormal stress on tendons.
Inadequate Warm-up or Cool-down: Muscles and tendons that aren't properly prepared for activity or given adequate recovery time can be more vulnerable.
Muscle Imbalances or Weakness: Weakness in surrounding muscles can force other muscles and therefore tendons to work harder than they can handle.
Age & Hormone Changes: Tendons can become less elastic and more susceptible to injury with age or hormone changes.
Equipment: Improperly fitted shoes, tools, or sports equipment can lead to poor body mechanics or friction in an area.

Common Types and Locations of Tendinopathy

Tendinopathy can occur in almost any tendon in the body, but some areas are more commonly affected due to their involvement in repetitive movements:

Achilles Tendinopathy: Pain and stiffness in the Achilles tendon (at the back of the ankle), common in runners.
Patellar Tendinopathy (Jumper's Knee): Pain below the kneecap, common in sports involving jumping.
Rotator Cuff Tendinopathy: Pain and weakness in the shoulder, affecting the tendons around the shoulder joint.
Lateral Epicondylitis (Tennis Elbow): Pain on the outside of the elbow, affecting forearm extensor tendons.
Medial Epicondylitis (Golfer's Elbow): Pain on the inside of the elbow, affecting forearm flexor tendons.
Gluteal Tendinopathy: Pain on the side of the hip/buttock.
Hamstring Tendinopathy: Pain at the back of the thigh, near the sitting bone.

Symptoms of Tendinopathy

The symptoms of tendinopathy typically develop gradually and worsen with activity:

Localized Pain: A dull ache or sharp pain directly over the affected tendon, often worse during or after activity.
Stiffness: Especially noticeable in the morning or after periods of rest.
Tenderness: Pain when the tendon is touched or pressed.
Swelling: May be present, though often subtle.
Weakness: Difficulty performing movements that involve the affected muscle-tendon unit.
Crepitus: A creaking or grating sensation when moving the tendon.

When to Seek Professional Help

It's advisable to seek professional help if:

Your pain is persistent and doesn't improve with rest or self-care.
The pain significantly interferes with your daily activities or sleep.
You notice significant swelling or deformity around the area.
You suspect a more severe injury, such as a tendon tear (which may involve a sudden, sharp pain and inability to move the associated joint).

Treatment and Management

The primary goal of tendinopathy treatment is to reduce pain, support the tissue, restore function, and prevent recurrence. This often involves a structured rehabilitation program, with physical rehab playing a central role:

Relative Rest/Activity Modification: Reducing or modifying the activities that aggravate the tendon, rather than complete immobilization, which can weaken the tendon further. This can sometimes include a brace or support to off-load the tissue and allow it to rest.
Load Management: This is crucial. An Athletic Therapist or Physiotherapist will guide you through a progressive loading program, gradually increasing the stress on the tendon to stimulate healing and strengthen the tissue. This might start with isometric exercises and progress to eccentric, heavy slow resistance, and finally, sport-specific exercises.
Pain Management: Ice or heat, whichever feels better during and after application. Pain medication under the advice of a physician.
Manual Therapy: Hands-on techniques to improve joint mobility, address muscle imbalances, and promote healing.
Stretching and Strengthening: Addressing any muscle tightness or weakness that contributes to the tendon overload.
Biomechanical Correction: Identifying and correcting faulty movement patterns or ergonomic issues.
Education: Understanding your condition and the importance of adherence to the rehabilitation program is vital for long-term success.
Lifestyle Adjustments: Ensuring adequate nutrition, hydration, and sleep to support tissue healing.

Tendinopathy can be a frustrating condition due to its chronic nature, but with a consistent and evidence-based rehabilitation approach, significant improvement and a return to full activity are very achievable.

If you're struggling with persistent tendon pain, don't let it limit you. Book today for a thorough assessment and a personalized plan to get you back to optimal function!

Get Help Today

Nikki Smith