Tendon Injuries – How do I know if I have Tendinopathy?

A graded progressive approach to exercise is the best way to commence any new exercise regimens for tendon health. When you increase your training load too quickly you can cause your tendons to overload and they can be damaged. Tendinopathies, which is a fancy term for tendon overload, can lead to a breakdown in function and rupture of your tendon if left unchecked.

So how do you know if you have tendinopathy? What do you do about your tendon overload and associated pain?

Tendons connect your muscle to your bone. The main role of your tendons is to transmit the force from your muscle to your bone and to generate movement. Your tendon is made of collagen. When you are at rest the collagen fibres are organised in a crimped pattern, with many individual myo-fibers making up each crimp.

If your tendon is placed under strain, a normal tendon will allow the tendon fibres to form strong parallel and linear patterns. This helps with energy storage and release for movement to occur. When this strain is finished, the tendon bundles revert back to their original form. Tendons can be very strong – for example, a tendon can pull off a piece of bone from the insertion of your tendon creating an avulsion fracture.

How does your Tendon become damaged?

Overloading your tendon can cause it to become irritated or damaged. The irritation to your tendon then makes it stiffen up and become thicker. This is called reactive tendinopathy. During this phase, your tendon still has the capacity to change back to normal. However, if not managed properly during this time, your tendon can progress from reactive tendinopathy to tendon disrepair. Constantly overloading your tendon creates a change to the tendon collagen fibres. They become disorganised and then weaken.

As time progresses the tendon becomes completely degenerated. This is called degenerative tendinopathy. The sections of the tendon that are degenerated & damaged are now unable to regenerate themselves and irreversible damage occurs. If the degenerative part of your tendon is widespread enough, eventually you will get partial tears in your tendon and a full tendon rupture may occur. Degenerative tendinopathies are most often occur in the older people however anyone with continual overload, even younger athletic people can get degenerative tendinopathies.

Do I have a Tendinopathy?

Here are a few signs and symptoms that you can watch out for
Increased pain at the site of the affected tendon. This is often after an increase in physical activity or sport.
Load related pain. Pain can be there when you start an activity, disappear during the activity, and then again during your cool down.
You can pinpoint the pain. Most people with tendinopathies are able to point exactly where their tendon pain is felt.
Your pain may be described as severe or even sharp during the early stages of tendinopathy and then it can revert to a dull ache once it has been there for a few weeks.

Tendinopathy Predisposition

Age: For example, patella tendinopathies are usually more common amongst adolescent athletes, whereas, Achilles tendinopathy is more common throughout the adult years.

A previous injury to the tendon itself or in the region above and below the painful section.

Family history of tendinopathy

Living a sedentary lifestyle

How can I help fix my tendon pain?

There are a variety of helpful things that can start to do to assist in the healing of your tendinopathy. This can range from moderating the exercise you do, taking into account any external influences that may be contributing to your pain to commencing a structured exercise program designed by your physiotherapist.

Moderating your exercise program
If you stop all activity and only rest your tendon you may be doing more harm to your tendon than you realise. For optimum tendon health, your tendon requires a constant stimulus to stay strong. With specific tendinopathies, there is usually an aggravating activity for your tendon pain. This may be running for Achilles tendinopathies, squatting down for patella ( knee cap ) tendinopathies or throwing for a supraspinatus (rotator cuff) tendinopathy of the shoulder. The best initial treatment is to moderate these activities by changing the stress load on the tendon. You might achieve this by walking instead of running, performing kinetic link posterior chain exercises only performing lower than 90 degrees (shoulder height ) pulling based resistance exercises.

How do I know which exercises I should or shouldn’t do?

We know from research that isometric based strengthening of tendinopathy significantly reduces pain (these are exercises without movement) and these exercises also improve the muscular strength in your tendon significantly.
From here it can get tricky though as what is the correct exercise and load for one person may be quite different from another person. The isometric exercise must be heavy enough that it is quite hard to perform but not so hard that you are shaking. So, for one person this might consist of a bodyweight double leg calf raise, and for another person, this may be single leg weighted calf raise.
Your physiotherapist at City Physiotherapy will be able to determine which exercises are appropriate for you, when and how to progress them.

How long does tendinopathy take to get better?

If you seek treatment early the tendinopathy disrepair phase it can take approximately 2-6 weeks to start to reduce in pain levels, once treatment has begun. This depends greatly on the severity of the tendinopathy and to how well you stick to your modified exercise and rehab program. After the initial stage, it will usually take another 6-12 weeks to restore back to full function. Your physiotherapist will guide you and will also look at any other predisposing factors such as postural issues and biomechanical imbalances that may be required to be addressed as well as treating any additional soft tissue or structural issues that could impact on your tendon health down the track. The key is to seek treatment early to avoid irreversible tendon damage.