Tendons are tough cord like structures that connect muscles to bones. Much like a rope, they are made up of many fibres that are arranged in a very specific and organised way to give them strength. In some people repetitive activities and overuse can injure tendons leading to pain and impaired function.
There is increasing evidence that overuse injuries to tendons aren’t just a result of the tendon becoming inflamed. Instead, the fibres that make up the tendon can lose their strength and structure making them less able to withstand the loads and forces placed on them.
This often results in a repetitive cycle of injury followed by poor quality healing which makes the tendon less efficient, thickened and painful. This is known as ‘tendinopathy’.
The causes of tendinopathy are not fully understood. Repetitive movements and over activity are thought to be common causes; however, some sedentary, relatively inactive people also develop problems.
Some factors that could increase the risk of injury are:
- Inefficient movement patterns
- Unaccustomed activity
- Lack of flexibility or weakness in your muscles
- Incorrect equipment or poor technique
What are the symptoms?
The symptoms of tendinopathy may differ from person to person. Common symptoms are:
- Pain, stiffness and loss of strength in the affected area
- Increased pain and stiffness during the night or when you get up in the morning
- A creaky sound (crepitus) when you use the tendon
Treatment will differ depending on the stage of the problem but is mainly a combination of some rest to help the injured tendon heal, pain relief and exercise to improve muscle strength and flexibility. Your physiotherapist will devise an appropriate treatment plan with you.
Rest: This is most important when you are first aware of pain or swelling, particularly if you notice the tendon is ‘creaky’. Resting from painful activities at this stage could prevent a longer term problem developing. Attempting to identify any potential causes could also help to prevent any recurrence.
Pain-relieving medications: It is now widely recognised that many tendon problems occur without inflammation, thus the benefit of anti-inflammatories is questionable. Over-the-counter pain relief such as paracetamol may be more beneficial and ice applied for ten minutes two or three times a day can help.
Exercises: Research shows that strengthening and stretching is one of the most effective ways to treat tendinopathy.
Under the care of your physiotherapist an exercises program to strengthen the affected area can be started. It is common to experience some discomfort while performing the exercises. It is also usually possible to continue some level of activity as long as any changes in the symptoms are closely monitored with your physiotherapist.
It is important to understand that tendons take time to heal and strengthen. It can take around six to eight weeks for an uncomplicated tendinopathy to heal, whereas a more chronic complicated tendinopathy may take up to three to six months to fully recover. Timescales may vary between individuals.
How can I prevent a tendon injury from re-occurring?
It is important to continue the maintenance exercises and advice provided by your physiotherapist. Try to remain mindful of possible causes if any have been identified. Sometimes it is necessary to modify your activities or how you do them. Your physiotherapist will be able to discuss these issues with you as part of your individual treatment plan before you are discharged.
What do I do if my symptoms do not improve?
Some tendinopathies are very resilient to treatment. If your condition does not significantly improve then some additional tests such as an MRI or ultrasound scan may be recommended. These provide clear images of the soft tissues and can also check for any other possible causes for your symptoms.
ShockWave Therapy can be used on tendons, which can promote healing and provide pain relief
Various injections can also be considered if you are not improving. These can include a steroid injection that can sometimes help to settle down the pain and any associated inflammation or irritant injections such as PRP.
In some rare and extreme cases a referral to an orthopaedic consultant may be recommended to assess whether an operation could help.
Treatments for Tendinopathies
Tendinopathies can be resilient to treatment but most do get better with a combination of the following treatments: