Tendinopathy is a very common condition and is often caused because you have changed your activity in some way, which increases the load and demand on the tendon faster than it can adapt, resulting in pain.

What is tendinopathy?

A tendon is a strong band of fibrous tissue that connects a muscle to a bone.  The function of a tendon is to assist the muscle to move the bone in a specific direction and to absorb and bear a large amount of load.

Tendons are found all over the body and common tendinopathies occur in the Achilles, Patellar, Gluteal area, Rotator cuff, Hamstrings and Medial and Lateral Epicondyles (tennis and golfers’ elbow).

Tendinopathy is also referred to as tendonitis or tendinosis but we now know that the tendon does not usually become inflamed but is a result of load intolerance or degeneration, so Tendinopathy is the most accurate term.

Why have I got Tendinopathy?

Tendinopathy is a very common condition and is often caused because you have changed your activity in some way, which increases the load and demand on the tendon faster than it can adapt, resulting in pain.  Tendons are designed to absorb large amounts of load.  However, if there is a sudden change or increase in load (for example this might be your walking/ running pace, frequency, duration, change in terrain or starting a new activity), then it can result in a reaction in the tendon.

You may not be able to associate the onset of your pain with any change in activity and therefore your tendon symptoms can be a result of degeneration or irritation.

There are several other risk factors which may increase the likelihood of developing Tendinopathy, which include:

  • Family History
  • Obesity
  • High levels of cholesterol
  • Arthritis
  • Diabetes
  • Taking a certain type of antibiotics (Quinolone group)
  • Achilles and Patellar Tendinopathy are more prevalent in those who regularly participate in high impact sports such as running, jumping, basketball, racquet sports, dance and gymnastics
  • Evidence has shown a strong link between hormonal change associated with menopause and developing tendinopathy.  This is thought to be because reduced hormones such as oestrogen and progesterone affect the collagen and tensile strength of the tendon.  This is why tendinopathy is very common in peri-menopausal and menopausal women and will affect 1 in 4 women over the age of 50.

Symptoms of Tendinopathy

Tendinopathy can have a significant impact on quality of life with severe symptoms that can interfere with sleep, day to day activities and hobbies.

Typical symptoms include:

  • Tenderness when touching the tendon
  • Pain which worsens during increased activity and exercise or afterwards
  • Morning stiffness and pain

Diagnosis

Your Physiotherapist or GP will conduct a physical examination as well as take details of your medical history and symptoms to confirm the diagnosis of tendinopathy and rule out other possible disorders.  Sometimes an MRI or ultrasound scan may be indicated.   

Treatment

Recovery will take several weeks but most often takes several months depending on the severity of pain and how long the symptoms have been present.  If diagnosed and treated early, the more effective treatment will be and the quicker the recovery.

Treatments that can help:

Ice or heat?

In the first six – eight weeks you can apply an ice pack to the tendon at intermittent intervals to help reduce pain. Wrap some ice/ peas in a tea towel and put it over the painful area for 10 minutes.  If your symptoms have been present for over eight weeks you may find heat offers more relief.  A hot water bottle is the perfect heat source to use but always apply it over clothes or a towel.

Pain medication

Over the counter medications such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen can be helpful in managing the pain.  It is important to get advice regarding suitable medication from a GP, Pharmacist or well-trained Physiotherapist.

Rest

Rest will not resolve tendinopathy but it will help your symptoms settle so it is important initially.  The pain may settle but, if you return to the previous level of activity, it is more than likely your symptoms will return.

Modify activity

It is important to rest the affected area from activities that increase your pain but do not stop activity completely.  We recommended engaging in alternative forms of exercise such as swimming and cycling to reduce the load on the tendon.  Your Physiotherapist can help guide you with this.

Exercise

Exercise is the gold standard for treating tendons!  Research confirms this is the ONLY way to resolve tendinopathy.  Exercise is the only way to strengthen the tendon and increase its ability to tolerate the load and cope with the activities you want to do.

For an optimal recovery a progressive, consistent exercise programme should be followed for at least 12 weeks to allow the tendon to adapt.  It is important that the tendon is loaded in a way that does not aggravate your symptoms and therefore it is best to have the guidance of a Physiotherapist.  Your Physiotherapist will also be able to identify any other contributing factors such as posture, biomechanics and weaker areas that may influence your recovery.

Unfortunately, rehabilitation is rarely linear.  It is common to have a flare-up, especially as when you feel better it can be easy to do too much.

Extracorporeal Shockwave Therapy (ESWT)

Also known as Shockwave Therapy.  It is a non-invasive treatment that uses high energy sound waves to stimulate and accelerate the healing process and give pain relief to soft tissue conditions including Tendinopathy.

The National Institute for Health and Care Excellence (NICE) offers evidence-based recommendations for NHS users and healthcare professionals on the treatment of musculoskeletal conditions.  NICE guidelines support the use of shockwave therapy for Tendinopathy as the evidence of its effectiveness is very good.  We offer Shockwave Therapy at Inkberrow Physiotherapy & Acupuncture and you can read more about it here.

Stretching

For some, stretching gives relief, but for others it makes symptoms worse.  If you do feel you need to stretch then take note of how it feels at the time and the following 24 hours.  If it makes your symptoms worse, then hold off the stretching.

Massage

You can massage over the muscle belly but it is advisable to avoid the tendon itself as this is likely to irritate it further.

Injections

It can be tempting to consider treatments such as injections but exercise is the ONLY way to improve the tendon’s strength and tolerance to cope with the loads and demands you put on it.  Research shows corticosteroids are likely to offer short-term relief but offer no additional benefits after 12 weeks.

Surgery

This is very much a last resort and is only sometimes an option if there has been no improvement after two years and with a consistent and progressive rehabilitation programme.

Helping you live your healthiest and happiest life. Revival Health & Wellbeing Centre offers a variety of treatments, clinics, counselling and holistic therapies from our specialist team of practitioners.

Please contact us on 01386 792 126 to discuss your consultation.