Here is some informative information for tendinopathy sufferers
Tendinopathy – it can affect any tendon!
Has it affected you??
We have all heard of tendinitis before. “Old mate over the fence who developed tennis elbow doing the gardening and not playing tennis a game of tennis since his 20’s, now he has got tendititis!!”
Thinking around tendinitis has changed a lot of the years. We have got much smarter then the sentence describing “old mates’ problem above. We now know there is less ‘itis’ or inflammation present and more changes happening within the tendon and its make up that causes tendon pain and interference with day to day activities. .
Science has found that initially there may be some ‘itis’ present, but the prolonged discomfort and interference the complaint has come down to the health and structure of the tendon itself, hence the ‘opathy’ replacing ‘itis’ at the end.
There are 3 common classifications of tendinopathy
- Disorganised or in disrepair
- Degenerative (tendinosis)
To put them simply;
A reactive tendinopathy will flare up easily with sudden increases in load. It ‘reacts’ to the workload place on it and pain is experienced by the sufferer, either immediately or after some time.
A disorganized tendinopathy or atendon in disrepair, is a thickened tendon that has enthusiastically remodeled and layed down more tissue in all kinds of directions and thickened a bid to withstand the increase in load. This type of tendon is less functional and can be reactive at times as well with sudden increases in load.
A degenerative tendinopathy is one where it has persisted for a period of time and rather then remodel and get better, it breaks down more then it rebuilds and tears can be reported on in scans. Degenerative tendons can also be reactive, again when the load on that tendon increases rapidly.
Pain is commonly the sign that all sufferers report interfeers with day to day activities and enjoyment. The pain experience in a tendinopathy is much to do with the sensitivity of the nociceptors (your receptors in tissues that pick up on information that can be felt as pain once processed by the brain), and the nervous system that relays nociception to the brain. In other words, the experience of pain that you have with a tendinopathy is due to the hypersensitive pain pathways and not always well correlated with the amount of tissue activity, damage or harm. You can read more about sensitivity of tissues in a previous blog HERE.
What treatment is available for a tendinopathy? Do injections, PRP (Plasma Rich Protein) and medications work?
They have can their place in a comprehensive tendon rehab plan. But soley by themselves are commonly not going to ‘fix’ the problem. This is why you hear so many people say I have had multiple injections but they never seam to work.
In the short term a coricosteriod injection (Local anaesthetic and steroid) will help to numb the pain pathways and if done early enough the steroid may at best promote tendon repair.
A PRP injection is more useful with a stubborn degenerative tendon, again early on when in disrepair. The PRP is utilized to insert natural growth factors back into the tendon and promote healing.
Medication can be useful but have limited long term benefit on their own. An anti-inflammatory may help settle a reactive tendon only if inflammation is present.
If you only use these quick fixes then the likely hood of failure is high. The reason why, you will always do what you have always done and jump back in there thinking its fixed only to load it too much and too quickly. Which results in it flaring up again, and again and probably many more times again.
What is a comprehensive tendon rehab plan?
It may be to use the above to begin or part way through the plan to break a stubbon tendons cycle of being reactive, going into disrepair or degeneration.
But the most important aspect is…
A progressive tendon loading program. In other words exercise/s that gradually rather then rapidly loading the affected tendon. This allows a number of important processes to occur that allows recovery from tendinopathy. Gradual and progressive loading promotes remodeling and repair of a disorganized or degenerative tendon and winds down the sensitivity of the tissues, nociceptors and nervous system to load.
3 key points to an effective tendon loading program
- Develop a tolerance – load the tendon appropriately and enough to feel some exercise effect or discomfort, but not enough to make it react with a flare up in pain
- Progressively load – add load to the tendon appropriately over time until it become easy, comfortable and tolerable. Then load it more as it adapts.
- Persistence – depending on the make up of the tendon, they are not fixed overnight and take time and commitment to recover from. There is no quick fix.
Tendinopathy can occur in many different tendons of the body. Here is just a few..
- Biceps, supraspinatis, infraspinatus around the shoulder
- Quadriceps and patella tendon
- Adductor or groin
The principles of rehabilitation remain the same! Appropriate loading that is functional and specific to the persons needs whether its sports, everyday activities or exercise.
If you would like a comprehensive tendinopathy rehab plan Click FOR YOUR APPOINTMENT HERE!
Below is a simple diagram of tendinopathy from BJSM.