Tendinopathy: 5 Things You Need to Know
What are tendons?
Your body is held together by tendons, bands of fibrous connective tissue that attach your muscles to your bones and help you move. Your tendons are impressively strong and yet they’re easily injured.
What is tendinopathy?
Tendinopathy is a tendon disorder that develops when the collagen in your tendon breaks down.
That causes pain and reduces both your flexibility and your range of motion.
It's often caused by overusing your tendon or putting it under sudden stress. Getting older or having low muscle tone can make tendinopathy more likely.
Here are 5 key things to know about tendinopathy:
1. Tendinopathy can get worse if you ignore it
With tendons, as with relationships, it's important to take action in the early stages of a problem when there's more chance of fixing it.
Tendinopathy has three different stages (the lines between each one are a bit blurry). You might have:
- Reactive tendinopathy, a short term change in your tendon due to a rapid increase in loading (have your runs intensified?) or a trauma. Structurally, your tendon is intact and there’s little change to your collagen. Your tendon may revert back to normal if you ease up and stop overloading it.
- Tendon dysrepair, where the collagen in your tendon breaks down due to persistent overuse. There will be signs of nerve and blood vessel ingrowth. With the right exercises, it may still be possible to reverse some of these changes.
- Degenerative tendinopathy, where there are many structural changes in your tendon that make it thicker and less able to manage a load (there’s a risk it could rupture). Your tendon is unlikely to go back to normal. This only really occurs in older people, or in chronically overloaded tendons (such as athletes, those with physically demanding and repetitive jobs, avid gym-goers etc.).
To pick up the relationship analogy again, tendinopathy is a sign you're in trouble with your partner. Now, if you choose to apologise quickly and admit you're a moron, all may be forgiven (reactive tendinopathy). But if you constantly do things that hurt your other half, you'll put severe pressure on the relationship over time (tendon dysrepair). And, if you don't change your ways, your relationship may end up past the point of healing (degenerative tendinopathy).
2. Complete rest doesn't help tendinopathy
However tempting it is, it’s not helpful to avoid all activity just because it hurts. The key thing is to manage the load you place on the tendon.
It's a balancing act. Do too much and you'll aggravate your sore tendon, do too little and there's no stimulus for positive adaptation. Finding the balance involves a bit of trial and error. But the take-away message is that complete rest is bad advice; you should find some tolerable amount of exercise and progress slowly from there.
What does that mean in practice?
Here are some ideas to consider (depending on advice from your treating physio):
- Maintain your fitness by cross-training that’s easy on your tendon such as swimming, cycling or gentle gym work
- Start loading your tendon by walking
- When you can walk without pain, try brisk walking, then jogging on the spot
- When you’re ready to run, start with short distances and a walk-run pattern
- Increase the duration and intensity slowly
- Monitor your pain levels during the activity and 24-48 hours afterwards (tendons can have a latent response which means they don’t put in a formal complaint until 1-2 days after the event).
Anecdotally, some patients report feeling worse when running first thing in the morning so make sure you toy around with the time you choose to exercise.
Tip: don’t stretch your muscle as it can irritate reactive tendinopathy. If your muscles feel tight, try a foam roller or massage ball but don’t put too much pressure over your tendon.
3. The right treatment for tendinopathy depends on its stage
There’s no one-size-fits-all approach to treating tendinopathy. The right thing in the early stages may be the wrong thing if you have a more advanced case. That’s why it’s so important to be properly assessed by a physiotherapist.
If you’ve hurt your Achilles tendon, then heel drops may help if you have late stage tendinopathy but do more harm than good if you have early stage tendinopathy. You need the right kind of rehab for your stage of tendinopathy.
To continue the relationship analogy, you need to know what you’ve done to annoy your partner before you decide how best to fix it. If you’ve been a slob around the house, then it’s time to clean up and do your fair share of the housework from now on. If you’ve forgotten your anniversary, then you probably need to do something more romantic than vacuuming…
4. Load management is really important in reactive/early dysrepair tendinopathy
Remember, early stage tendinopathy means that, with careful treatment, you may succeed in reversing the damage to your tendon.
The most important concept in this stage is load management, including:
- Tensile loads (that stretch your tendon): If you've hurt your Achilles tendon, you can redude its tensile load by:
- Decreasing how far you run
- Decreasing how fast you run
- Taking a short break from running.
- Compressive loads (that squash it): If you've hurt the tendons around your hips and hamstrings then be aware that you compress these tendons when you sit down (so get off your butt for a bit to reduce the compressive load).
Some activities involve both tensile and compressive loads, which can thoroughly provoke a sore tendon. Think of the work involved in lunging, running uphill, or stretching the hamstring muscles.
There is an element of trial and error involved as you learn how your body responds (as this may differ from the theory!).
5. A single tendon can have both reactive and degenerative tendinopathy
To complicate matters, you can have a single tendon that has both reactive parts and degenerative parts. In this case, the same tendon will show signs of both early and late-stage tendinopathy. It’s the worst of both worlds.
The degenerative parts of your tendon are now always there. You will need to manage these on an ongoing basis by:
- Managing your load
- Incorporating loaded work within pain limits as directed by your physio
Examples of concentric, eccentric and isometric muscle contractions. These contractions can occur in any muscle in the body.
From time to time, you may also experience a temporary reactive tendinopathy in the normally healthy parts of your tendon. This can happen if you’ve overused the tendon – perhaps you’ve increased the volume or intensity of your exercise. If that’s the case, then follow steps 2-4 above under the guidance of your physio.
How can Sycamore Health help?
Your tendons do an important job in your body and you should listen to any warning signs they’re giving you. If you’re in pain, then please come to see us for a full assessment and treatment plan.
Reactive tendinopathy often settles quite quickly if you treat it properly. Pain may settle in 5-10 days but you still need to treat your tendon gently for a bit longer, gradually increasing loads and monitoring your tendon’s response. Degenerative tendinopathy needs ongoing work within pain limits.
Tendons are complex structures. We can help you understand what tendinopathy is, how to treat it, and what to look out for. We can monitor your progress and discuss other options with you if conservative treatment isn’t working. Please make an appointment.