Tendinopathy

What is Tendinopathy?

 

• A tendon is a band of tissue that connects muscles to bones.
•  Tendinopathy refers to a group of conditions involving the tendon, which are characterized by structural tendon changes and clinical symptoms of pain and limited function. 
•  Tendons become tendinopathic, when they experience high loads, beyond their capacity. This can often happen when you have increased your training load suddenly.

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• The bucket and water analogy is a useful way to describe what is happening when a tendon exceeds its ‘capacity’ and becomes symptomatic. 
• The bucket represents your tendon capacity, and the water is the load (the amount of activity you are doing). If you have a small capacity, and suddenly you increase your load, all the water will flow outside the bucket, and then you start to experience pain and dysfunction.
•  If your bucket (your capacity) is bigger, it is possible to load the tendon further.  
• In the lower limb, tendinopathy is common in the patellar, achilles, and proximal hamstring tendons. Common upper extremity tendinopathies include rotator cuff injury, lateral and medial epicondylitis.
• In jumping sports, where the patellar tendon is repeatedly loaded, patellar tendinopathy is common. In runners, achilles tendinopathy is common, with the Achilles tendon subjected to forces approximately six to eight times a person’s body weight whilst running, which is nearing its maximum load tolerance.

​How do we manage tendinopathy?

• Since tendinopathy is thought to result from the incongruence between the load placed on the tendon and its load capacity, consideration of the tendon load is essential to its management.
• Whilst you may think rest will help your symptoms, complete rest may only make matters worse, as the tendons capacity is decreased further and therefore your ability to bare load also declines.
• A graded loading programme is key to your management. 
• This may start with isometric exercises, which have been found to have pain relieving effects. Heavy slow resistance programmes or eccentric exercises may then be suggested to rehabilitate the tendon. 
• Knowing how much to load the tendon can be challenging. A physiotherapist can work with you to help guide you through this process.

*New research* - Pavlova AV, Shim JSC, Moss R, et al (2023) ‘Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis British Journal of Sports Medicine 2023;57:1327-1334.

• New research into tendinopathy management released this October, found that exercise programmes that involved added loads (dumbbells, TheraBand’s, weighted machines etc) were found to be more effective for treating tendinopathy than compared to just using body weight exercises.
• Completing rehabilitation sessions at a higher intensity, with added load and then allowing of sufficient recovery was also found to be more effective than a high frequency of sessions at lower intensity.

​Addittional treatment 

• For unresolving tendon pain, Shockwave therapy is also a useful management strategy. 
• The treatment involves low energy soundwaves (shockwaves) being delivered by a handheld device to the painful area to stimulate a healing response.
• You can read more about this on our Shockwave Therapy Page.

If you are suffering with what you think may be a tendinopathy, then call for help and you can discuss with one of our team a plan to get you back to your best! 

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Bath Physio & Shockwave
​01225 683007