Tendon Talk: Your Guide to Tendinopathies and How to Manage Them
Tendons are essential structures that connect muscles to bones, allowing us to move efficiently and powerfully. However, tendons are susceptible to various issues, known as tendinopathies, which can cause significant pain and limit movement. In this blog, we will explore what tendons are, how they function, common types of tendinopathies including Achilles and Rotator Cuff tendinopathies, prevention strategies and how physiotherapy can help.
Tendon Talk: Your Top FAQs Answered!
What Are tendons?
Tendons are strong, fibrous tissues that connect muscles to bones. They act like springs, absorbing, storing, and releasing energy to facilitate smooth and powerful movements. Healthy tendons glide effortlessly, enabling efficient performance of activities like running, jumping, and lifting. When tendons are overstressed or injured, they can become painful and dysfunctional, leading to tendinopathies.
The term Tendinopathy refers to pain and dysfunction in a tendon. It happens when the tendon doesn’t heal properly, leading to disorganised cell growth, changes in the tendon’s structure, and more non-collagenous material around it. Essentially, tendinopathy is a broad term for problems related to overusing tendons, which results in pain, decreased function, and challenges with exercise.
How tendons respond to load
Why Exercise Load Matters for Tendon Health
Tendons are designed to handle stress and adapt over time. Gradually increasing the load on tendons helps them become stronger and more resilient. However, abrupt or excessive increases in load can overwhelm tendons and lead to injury.
Managing exercise load is essential for optimising fitness and overall health. Striking the right balance ensures your body receives the appropriate stimulus to develop strength, endurance, and flexibility while avoiding overtraining or injury. Adjusting exercise intensity and volume effectively helps you challenge your muscles and cardiovascular system progressively, promotes recovery, and enhances performance. By carefully monitoring and adjusting your exercise regimen, you can achieve your fitness goals sustainably and healthily.
Key Points for Proper Tendon Loading:
Gradual Increase: As a rule of thumb, increase the intensity and duration of your activities by no more than 10% per week. This gradual approach helps tendons adapt without becoming overstressed.
Regular Exercise: Maintain consistent, moderate exercise to support tendon health and prepare effectively for events. Regular training strengthens tendons and improves flexibility, helping you perform at your best and reducing the risk of injury.
Adequate Rest: Allow sufficient recovery time between activities to prevent overuse injuries. Use training splits, such as alternating between long and short runs throughout the week, to give your tendons the necessary rest and adaptation periods while maintaining overall fitness.
Don’t ignore those niggles!
Common tendinopathies we see in the clinic:
Here are a few common tendinopathies we frequently encounter in our physiotherapy clinic, and names you may have heard before:
Achilles Tendinopathy
Location: Back of the lower leg, where the Achilles tendon attaches to the heel bone.
Symptoms: Pain and stiffness in the heel, particularly with activity. Pain may worsen during or after running or jumping and a noticeable lump, known as Haglund's deformity, might be present.
Causes: Overuse, sudden increases in activity, poor footwear and biomechanical issues of the lower limb.
Glute Medius Tendinopathy
Location: Side of the hip, where the glute medius tendon attaches to the pelvis.
Symptoms: Pain on the outer side of the hip or buttock. Discomfort often worsens when sleeping in sidelying and activities like walking or climbing stairs.
Causes: Overuse, muscle imbalances, weak glutes and excessive walking are all factors contributing to this condition. It is also common in women aged 40 and over due to hormonal changes.
Tennis Elbow (Lateral Epicondylitis)
Location: Outer part of the elbow.
Symptoms: Pain and tenderness on the outer elbow, often aggravated by gripping or wrist movements.
Causes: Repetitive stress from activities like racket sports, gripping tasks, repetitive lifting, or typing.
Golfer’s Elbow (Medial Epicondylitis)
Location: Inner part of the elbow.
Symptoms: Pain and tenderness on the inner elbow, which may extend into the forearm.
Causes: Overuse or repetitive stress from activities involving gripping or wrist flexion.
Rotator Cuff Tendinopathy
Location: Shoulder, where the rotator cuff tendons attach to the upper arm bone.
Symptoms: Pain and weakness in the shoulder, especially with overhead movements. Discomfort may increase with activities such as lifting, reaching, or rotating the arm and sleeping in sidelying on the affected side.
Causes: Overuse, repetitive shoulder movements, poor posture, and age-related changes.
Common symptoms of tendinopathies
Identifying the symptoms of tendinopathies early can help in effective management:
Pain: Typically localised to the site of the tendon, pain usually worsens with activity. In the early phases, there may be a warm-up effect where pain temporarily decreases with movement, but it often returns afterward. Avoid poking the area, as this can aggravate the condition further.
Stiffness: Tendons may feel stiff, particularly after periods of inactivity or first thing in the morning. This is especially common with Achilles tendinopathy, where many people will notice stiffness when walking down stairs.
Swelling: Tenderness and swelling around the affected tendon may occur, particularly if the condition is chronic.
Reduced Range of Motion: You may experience difficulty moving the affected joint through its full range.
Weakness: Decreased strength in the affected muscles is a common symptom of tendinopathy. For example, with Achilles tendinopathy, you might notice difficulty performing activities that involve pushing off with your foot, such as running or jumping. This weakness results from the tendon's compromised ability to handle normal stress and forces, which can lead to reduced power and stability in the lower leg muscles.
Preventing tendinopathies
Taking proactive steps can help prevent tendinopathies:
Warm-Up Properly: A well-rounded warm-up routine can improve performance and prevent tendon-related injuries. This should include dynamic stretching, mobility exercises, and strength drills to increase blood flow, enhance neuromuscular efficiency and warm-up the muscles.
Progress Gradually: Structured and incremental increase in training load is needed to enhance tendon resilience and strength over time. Gradual progression in activity levels is essential. The principle of progressive overload should be applied carefully to ensure that tendons adapt to increased stress without becoming overworked. Sudden increases in intensity, duration, or frequency of activities can lead to microtraumas in the tendon fibers, setting the stage for tendinopathy and bursitis.
Maintain Correct Form: Proper technique during exercises is vital for distributing stress evenly across tendons and muscles. Biomechanical assessments can identify improper movement patterns that can contribute to tendon stress. Addressing muscle imbalances through targeted strength training and ensuring that exercises align with the demands of your sport or activity can prevent excessive strain on tendons.
Allow for Recovery: Overuse injuries are often the result of insufficient recovery periods! Incorporating adequate rest and recovery into your training regimen is crucial for tendon health.
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How physiotherapy can help
Physiotherapy is a key component in managing and preventing tendinopathies. Here’s how a physiotherapist can assist:
Assessment and Diagnosis: A physiotherapist can evaluate your condition, assess biomechanics, functional measures, and objective outcomes to provide a clinical diagnosis and get to the root cause.
Personalised Treatment Plan: Develop a customised plan that includes targeted exercises to manage load, strengthen tendons, and improve biomechanics. This plan should also consider factors such as sleep, nutrition, and training load and variability to ensure a holistic approach to tendon health and recovery.
Guided Exercises: Physiotherapists provide safe, effective exercises for tendon loading and recovery.
Hands-On Treatment: Various manual therapy techniques can be used in conjunction with exercise to reduce pain and support healing, including soft tissue release, dry needling, taping, Instrument Assisted Soft Tissue Mobilisation (IASTM), and shockwave therapy. These methods aim to improve blood flow, release tension, and stimulate the body's natural healing processes, thereby enhancing tendon health and promoting recovery.
Are you experiencing pain or looking to prevent tendinopathies? Our experienced physiotherapist will assess your condition, provide personalised recommendations, and help keep you on the track, field, or court.