Tendinopathy is a disease of the tendon, it can develop in any tendons of the body including tendons found on the shoulders and arms, on the legs and hips, and the hands and feet. While the injury can develop in any tendons of the body, it occurs most often in the mid-tendon, in the tendon insertion, and in the musculotendinous junction. This painful condition commonly occurs as a result of overuse in and around the tendons.
Risk factors
The most widely recognized risk factor for tendinopathy is repetitive overloading. But there has been studies that found a link between diabetes and tendon damage, proving that overuse is not the only cause of the injury. In addition, evidence is growing that post-menopausal women and men with high body fat, and people who are constantly exposed to tobacco smoke are at a higher risk of developing the condition.
What are the Symptoms of Tendinopathy?
Signs and symptoms of tendinopathy commonly occur at the point where the tendon attaches to the bone.
Symptoms may include:
- A gradual onset of pain
- Mild swelling
- Pain that develops when you move
- Tenderness
- Worse pain during the night or upon waking up
- Red appearance of the affected area
Tendinopathy Phases
Tendinopathy involves an inflammation of the tendon. As the overload gets too intense for the tendon to handle, the condition can progress through four phases until there’s a total loss of function in the tendon due to tendon cell death.
1. Reactive Tendinopathy
The reactive phase of tendinopathy is characterized by inflammation. Recovery at this stage usually takes just a few weeks.
2. Tendon Dysrepair
During this stage, the tendon structure begins to change with greater breakdown physiologically. This stage occurs when the tendon is not offloaded and allowed to heal. At this stage, tissue is attempting to heal, so it is vital to prevent further deterioration and progression to stage 3.
3. Degenerative Tendinopathy
This stage occurs as a response of the tendon to chronic overuse. During this phase, cell death occurs, and collagen becomes disorganised, causing the tendon structure to be less efficient in managing the overload.
4. Tendon Tear or Rupture
This stage is where catastrophic tissue breakdown occurs. The person affected may experience an inability to use the leg or arm, and inability to bear weight. At this stage, the only option for treatment is surgery.
It is crucial to have your condition assessed by a specialist who can identify your tendinopathy phase. Knowing the phase of the condition helps your doctor or physiotherapist create a treatment plan that will be most effective for your specific case. Depending on your tendinopathy phase, you may be directed to do modification on your workouts to allow the tendon to return to its normal condition.
How is the condition diagnosed?
Your trusted physiotherapist will do an evaluation of your overall health condition, your medical history, your symptoms and your current exercise program. After the consultation, your physiotherapist will perform a physical examination to come up with a proper diagnosis. He or she will then provide you with early treatment options. If your symptoms do not improve with the initial treatment, you have may to undergo other diagnostic tests such as MRI or ultrasound scan.
How is Tendinopathy Treated?
There are many treatment options for tendinopathy, ranging from simple home remedies such as taking anti-inflammatory medication and resting, to more invasive treatments like surgery for more advanced stages. Your physiotherapist might suggest the following for early treatment:
- Reduce physical activity
- Rest the affected area
- Apply cold packs as often as two times every 60 minutes
- Do gentle stretching to prevent stiffness
- Elevate the foot to reduce swelling
- Go to physical therapy
How to Return to Sports
It may take several weeks or months for the injured tendon to fully heal, so it is important that you stick with the recommended treatment and be patient with the healing process. There are certain risks to using an injured tendon too soon, so to prevent further damage, refrain from doing strenuous physical activities while the tendon heals. Your physiotherapist may suggest long-term changes to your activities to help avoid any further damage to the tendon.
Here are some factors to consider as you return to doing normal activities:
- Try changing your activities or make changes in the way you do them
- If the injury resulted from exercise, consult your technique with a sports physiotherapist
- Perform eccentric exercises regularly
- Monitor your exercise loads and discuss them with your coach and physiotherapist
- Make sure to do warm up and cool down before and after your workout
How Physiotherapy Helps
Physiotherapy treatment plans have been used for the treatment of Tendinopathies. The duration of the treatment can take a few weeks as you have to go through different phases of the recovery. Physiotherapy focuses on speeding up the healing process and lowering the chances of recurrence, which is why at every stage of the treatment, different symptoms will be managed. For the first phase, your therapist will focus on relieving pain and swelling, while phase two is all about performing strengthening movements. Once your condition improves, you will enter phase three of the treatment where your therapist will prepare you to go back to doing normal activities.
The treatment plan may be lengthy, but it is important to be patient and trust the process. It is divided into phases to help you progress safely through recovery, so you don’t have to go through all the procedures all over again.
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