Many people suffer injuries to their tendons and get told they have a “tendinopathy” or “tendinitis” such as a rotator cuff tendon injury, achilles tendinopathy, patella tendinopathy. Other common injuries involving the tendons include tennis elbow, lateral hip pain and shoulder impingement.
So what is a tendinopathy?
To answer this question, we need to look at what is a tendon.
Tendons attach muscle to bone and allow movement at the joints. Each tendon is different depending on their functional requirements. Tendons are like springs in their ability to absorb and release energy but also be stiff to withstand load.
When loaded appropriately, the tendon adapts and becomes stiffer and more resilient. It does not become thicker. The structure of the tendon improves rather than the size of the structure.
However, it is also possible to under load a tendon often when returning from injury or from a change in activity levels. The tendon then becomes “stress shielded” where the superficial portion of the tendon takes too much load and the deep portion takes too little.
If not treated, and normal loads are placed through it, the “stress shielded” tendon can become a reactive tendinopathy.
The reactive tendinopathy will react by increasing the number of cells and matrix in the tendon structure causing it to thicken.
If the tendon continues to be loaded excessively, this then becomes a “tendon in dysrepair”. This is where the tendon thickens and the collagen separates and the matrix in the tendon becomes disorganised. New blood vessels and nerves are formed which account for the ongoing pain.
The reactive and disrepair tendon can return to a “normal” tendon if loading is modified and controlled. However, if this does not occur the tendon can become degenerative but good quality rehab can still affect even a degenerative tendon.
Pain is felt because of increased expression of the nociceptors which in turn increase the stimulation of the peripheral nerves and the brain interprets this as pain.
How do we treat tendinopathy?
An understanding the root cause of the injury is vital followed by load management. Initially de-loading (different from rest) the structures to settle the pain before beginning an exercise rehab program increase the load capacity of the tendon.
If you have a tendon injury, contact us now to book an assessment!!