What is a Tendinopathy:

Tendons are what attach muscles to bones. They are made up collagen (connective tissue found throughout your body) and cells called tenocytes which have a parallel arrangement.

There are three main types of tendinopathy or tendon diseases:

• Tendonitis: which is rare and refers to inflammation of the tendon
• Tendinosis: which involves changes to the matrix of the tendon cells which is more common is overuse injuries
• Paratendonitis: is inflammation of the tendon sheath which can be diagnosed under ultrasound and quickly resolved with rest and or a cortisone injection.

Symptoms of a tendinopathy:

• Pain and tenderness over the site of the tendon
• Localised swelling
• Pain or stiffness when putting load through the tendon (ie walking or throwing)
• Tendons often are sore at the start of an activity, pain then eases as the tendon warms up but then aches again once the activity is finished

Diagnosis:

Your physio will help determine what type of tendon injury you have. Imaging diagnosis is performed by ultrasound or MRI.

Tendon Rehab:

If the tendon pain in acute (less than one month) management needs to include an immediate period of rest to offload the tendon before commencing localised strengthening. If the pain has been there for longer than 3 months and the tendon cells have started to degenerate the management approach is different. Strengthening in this case tends to commence immediately. Tendon rehab is difficult as tendons don’t like being offloaded or having too much load.

In all cases of tendinopathy the factors contributing towards the tendon pain need to be addressed. These factors include:

•  Footwear
•  Load (including training or everyday life)
• Muscle strength
• FlexIbility and length
• Joint stiffness
•  Body weight

Time frames for recovery vary depending on how long the tendon has been sore for. In cases of chronic pain tendons can take up to 6-12 months to fully recover as the tendon needs time to replace its cells and for the matrix of the cells to be re-aligned.

Lindsay Young (APAM)

B. Physiotherapy

POGO Master