Tendinopathy

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Tendinopathy is a common sports injury that affects the tendon – it is associated with an excessive cumulative load to the tendon and can cause pain in the tendon. Tendinopathy is a term that means tendon pain and dysfunction; the pain is most often felt during tasks that load or put stress on the tendon, such as running, jumping, or throwing a ball.

Some patients use the terms Tendinopathy and tendonitis interchangeably. Whilst the two have almost identical symptoms, they are different conditions. Tendinopathy is a degeneration of the collagen protein that forms the tendon, whilst tendonitis, on the other hand, is just inflammation of the tendon. Additionally, studies have shown that tendinopathy is actually much more common, although, it is not recognized and diagnosed as often as tendonitis is.

Causes & Symptoms

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In some cases, Tendinopathy injuries will occur when a relative period of inactivity is followed by a period of increased activity. Some examples linked to Tendinopathy include the following:

 

  • Starting a painting project at home.

 

  • Cooking more than usual.

 

  • Increasing work habits due to working from home.

 

  • Increasing workouts or any regular exercise routine.

 

Generally, Tendinopathy does not have to be related to a certain sports activity or repetitive running activity; overuse injuries can come from a wide variety of non-sporting activities.

Tendinopathy commonly occurs on the shoulder and on the Achilles’ tendon of a patient (also known as rotator cuff tendinopathy and Achilles tendinopathy).

Rotator cuff Tendinopathy refers to any tendon injury in your shoulder, whether it is chronic or acute. Rotator cuff Tendinopathy is a common shoulder problem caused by an overload of a rotator cuff tendon, causing shoulder pain, inflammation, and sometimes stiffness. The pain can spread further down the arm and up towards your neck. It can feel worse when you move your arm during everyday movements / tasks such as reaching up, putting your hand behind your back, lifting, and carrying objects. As for the Achilles Tendinopathy, the Achilles’ tendon is a large tendon which is located on the back of the ankle. This tendon connects the heel bone to the calf muscle. It is also the strongest tendon in the body, allowing you to push your body onto the tiptoes, however, the tendon also bears a lot of stress. When the tendon experiences an increased or abnormal amount of stress from activities such as running, jumping, or standing for long periods, it can become very painful, swollen, and stiff. This is known as Achilles Tendinopathy. Some factors that contribute to Tendinopathy may include tightness in the calves or stiff joints. If an individual is experiencing pain or tenderness in the Achilles tendon, consulting a podiatrist is highly suggested due to the potential severity of the condition worsening over time. A podiatrist is a type of doctor who performs physiotherapy in the foot for any patient who most commonly experiences pain in their feet.

Who Gets Tendinopathy

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Athletes who regularly practice or participate in an overhand throwing or serving sports such as baseball, football, softball, tennis, track and field, and volleyball. Baseball pitchers are particularly vulnerable to rotator cuff injuries due to the repeated overhand motion of pitching, combined with the rotation of the shoulder. Load-bearing activities that cause you to lift heavy weights above shoulder level can also create trauma to the rotator cuff tendons (such as cheerleading, figure skating, and ballet dancing). Workers who raise their arms above their shoulder level are also at risk of Tendinopathy. House painters, construction workers, and factory workers are also at risk of experiencing this type of injury. If you work on loading heavy objects in any physical way, you could also be at risk – for example, if you are lifting something heavy over your head repeatedly. People aged 40 and over also have a chance of developing Tendinopathy due to the general wear and tear of growing older. Post-menopausal women are particularly susceptible to tendon issues, possibly related to a deficiency of estrogen. Studies indicate that being overweight and / or obese can put you at a greater risk for Tendinopathy, especially if you are a male. Lastly, diabetes and other metabolic disorders are another risk factor of Tendinopathy. Studies show that poor glycemic control may lead to build-ups in the bloodstream. These can contribute to inflammation and may ultimately weaken tendons.

How Does It Affect You? How Serious Is It?

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If a patient leaves his / her injury untreated, Tendinopathy can increase the risk of experiencing a tendon rupture, which is a much more serious condition that may require surgery. A ruptured tendon is when the fibrous tissue that attaches muscle to bone, tear or rupture. Signs and symptoms of tendon rupture include a snap or pop that you can hear followed almost immediately by severe pain. Other signs and symptoms include immediate or rapid bruising, weakness, and inability to use or move the affected area, swelling or deformity of the area, and the person’s inability to bear or lift the weight of the affected body part.

Recommended Treatment & Rehabilitation

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During a diagnosis, Tendinopathy typically is diagnosed by a physical examination alone – if you have symptoms of overuse Tendinopathy, your doctor may order an ultrasound or MRI scan to help determine tendon thickening, dislocations, and tears, but these are usually unnecessary for newly diagnosed cases. Your doctor can also assess whether you have similar problems such as bursitis. A physiotherapist may also help you to rebuild strength and stimulate tendon healing through gentle exercises. Your doctor can give you a referral to a physiotherapist. There are several techniques that a physiotherapist might use to treat Tendinopathy, however, two common ones include deep friction massage, a type of connective tissue massage that may help to stimulate cell activity and generate new collagen fibers.

Additionally, eccentric exercises, which force your muscles to lengthen whilst they contract, rather than shorten.

If you have severe Tendinopathy, your doctor may want to recommend a surgical procedure known as tendon repair surgery. They will also recommend you perform some physiotherapy during the recovery process, which often takes up to 12 weeks. Doctors often advise Tendinopathy patients to take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil).

Other anti-inflammatory medications used to treat Tendinopathy include diclofenac (a prescription-only NSAID), and injections of corticosteroids such as triamcinolone acetonide. It is worth knowing that there is growing evidence that NSAIDs may actually slow down the recovery process during the course of Tendinopathy. Doctors are therefore beginning to question this treatment approach, now that there is a better understanding of the relationship between inflammation and Tendinopathy.

Overall, Tendinopathy can affect different areas of the human body. Therefore, there are different exercises that are helpful for patients who are experiencing either Achilles Tendinopathy and Rotator cuff Tendinopathy:

 

Runner’s stretch

 

Firstly, place your hands on the wall or chair. If using a wall, put your hands at eye level. Secondly, step the leg you want to stretch behind you. Keep your back heel on the floor and point your toes straight ahead. Bend your other knee towards the wall, keeping your back leg straight. Finally, lean towards the wall until you feel a gentle stretch in your calf. Do not lean so far that you feel pain. Hold this position for 30 seconds, then complete 3 more repetitions.

 

Heel drop

 

Hold on to the railings of a staircase or ladder. Put the ball of your foot on the edge of the bottom step. Finally, let your heel drop down, allowing your other foot to relax. Hold the position for 30 seconds. Complete 3 more repetitions afterwards.

 

Reverse fly 

You first stand with your feet shoulder-width apart and your knees slightly bent. Keep your back straight and bend forwards slightly at the waist. With a light weight in each hand, extend your arms and raise them away from your body. Do not lock your elbow. Lastly, squeeze your shoulder blades together as you do so. Do not raise your arms above shoulder height. Return to start and repeat 3 sets of 10.

 

Side-lying rotation

 

Lie down on the side opposite your injured arm. Then, bend the elbow of your injured arm to 90 degrees and rest the elbow on your side. Your forearm should rest across your abdomen. Afterwards, hold a light dumbbell in the injured side’s hand and, keeping your elbow against your side, slowly raise the dumbbell toward the ceiling. It is recommended to stop rotating your arm if you feel the strain. Finally, hold the dumbbell up for a few seconds before returning to the start position with your arm down. Repeat 3 sets of 10 up to 3 times per day. Increase repetitions to 20 when a set of 10 becomes easy.

It is always recommended to find healthy ways to prevent further symptoms to occur. A prevention program should replace bad habits with these methods that promote a healthy workout, such as:

 

  • Warm-up more thoroughly, gradually building the intensity level of your workout. Then cool down properly after the session.

 

  • Train for a new sport before you start the chosen activity. Start by building strength and flexibility in the muscles you will use a few weeks or months in advance.

 

  • Learn the proper method and use the proper equipment for any exercise or activity. Work out regularly, even if more than once a week.

Alternative & Homeopathic Treatment

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Treating Tendinopathy usually starts with giving the injured area plenty of rest. But it is important to still be lightly active to maintain your strength and overall health. If your Achilles’ tendon is affected, for example, consider opting for low-impact activities, such as swimming. If you cannot avoid putting repeated stress on the area due to any job requirements, it is recommended to try for at least a minute of rest for every 15 minutes of work, or 5 minutes of rest for every 20 to 30 minutes of work. You can also try the RICE method, which is often very effective for tendon injuries:

 

  • Rest – Try to stay off the affected body part as much as you can.

 

  • Ice – Wrap an ice pack in a light towel and hold it to the affected area for 20 minutes. You can do this up to eight times a day. Heat packs may also help to allow circulation in the affected area.

 

  • Compress – Wrap the area in an elastic bandage, making sure it is not too tight.

 

  • Elevate – Keep the affected area raised on a pillow or other device. This can help to reduce any swelling.