Tendinopathy is a common yet very challenging ailment to both osteopaths and physios alike and is of particular interest to me, partly because it is often poorly diagnosed and mistreated. This blog explores all aspects of tendinopathy, and why it is important to get it right
Find out more about tendinopathy, how the disease can progress over time and the treatment options available to you.
Why Is It Called Tendinopathy And Not Tendinitis?
Tendinitis is an antiquated term and a lot of evidence now suggests that there are very few inflammatory markers present in the tendon when disrupted (meaning the ‘itis’ part of the name is incorrect).
This may seem inconsequential when looking into rehabilitation options, but using the incorrect terminology should bring into question your therapist’s knowledge, and I’m sure that you would want the most up-to-date plan with regard to your treatment.
A more accurate way to think about tendon pain and the correct terminology is that tendinitis is actually just one type of tendinopathy, and to call all types of tendon-related pain ‘tendinitis’ ignores the other potential issues.
What Is Tendinopathy?
Tendinopathy refers to any disease affecting the tendons in your body and it can result in pain when exercising or moving.
To explain the job of tendons in simple terms, they help to transfer forces from your muscles to your bones. When too much force for is applied over a period of time (particularly if you’ve not exercised for a while), you start to develop tendinopathy.
Tendinopathy is characterised by pain, swelling and limited movement. People will usually experience tendinopathy in the heel, knee, glutes, shoulder or elbow.
Tendon degeneration happens when there is a reduction in type I collagen (the protein found in connective tissues such as tendons) and an increase in the immature type III collagen. This change in collagen occurs as your body tries to repair the damage to your tendons, and the lower quality collagen is produced as it takes less time to form.
Healthy tendons are loaded with type I collagen, making them strong, durable and able to tolerate significant loads. As they degenerate and swap type I for type III they lose this ability, causing pain and swelling, and eventually, if you are extremely unfortunate, this can cause your tendons to snap.
The Three Stages Of Tendinopathy
Interestingly, healthy tendons can be twice as strong as muscles, so tearing rarely happens, unless they weaken over a much longer period of time. The degenerative process has three main stages that are clinically significant.
This phase is acute and can be very painful. The reactive phase tends to occur in younger patients, and the tendon will try to adapt and tolerate the increased load. In this phase, the tendon can still be fully repaired.
The dysrepair phase is characterised by more frequent and noticeable pain and tends to happen to people between the ages of 20 and 35. During this phase, the tendon is trying to heal but the structural damage has become profound enough that the damage is happening faster than the rate of healing.
This chronic stage may actually cause less pain but will cause a great deal of swelling to the affected areas. This being said, the degenerative phase of tendinopathy can have acute spells of more intense pain. This phase tends to happen between the ages of 30 and 60, but it can also happen after many years of plyometric workouts.
At this point, the tendon has stopped trying to heal and there is evidence of cellular death (apoptosis). This limited ability to heal means that the tendon will require urgent treatment.
How To Treat Tendinopathy
As you can see, the degenerative phase is dangerous due to the fact that there is can be little to no pain, with just a lump and reduced mobility the signs of any problem at all. The best strategy way to avoid this stage is to start looking after your tendons in the first place
Taking care of tendons is not too difficult, with osteopathy and physiotherapy the best methods to resolve any issues. The Clinic’s exercise programs are a cost-effective way to resolve the ailment, regardless of what phase it is in.
Depending on the severity of the tendinopathy, it could require a three to six-week exercise program. The final week should be repeated every so often in order to maintain tendon strength, particularly if you are in the degeneration phase.
To start looking after your tendons right away, drop me a line whenever you’re free and I’ll be happy to talk to you about your options.
CALL: 0161 209 3980