What is a Tendinopathy?
3) Provide absorption of energy. In the case of tendons such as the achilles and patella, this energy is stored momentarily and then transmitted back as elastic energy. This mechanism increase the efficiency of movements such as walking, running, jumping an hopping.
Whilst structures such as muscles can adapt rapidly (in weeks or months), tendons generally take months to years to undergo significant adaptive changes.
This makes them susceptible to injury when there are rapid changes in the stress levels they are put under.
Reactive Changes
Individual tendon fibres can start to undergo stress induced changes if exposed to a significant increase in stress levels over a short period of time. We term these stress induced changes a “reactive” tendinopathy
As a generally healthy tendon has a limited number of pain recepting nerves these changes may or may not induce a pain response. If you are reading this it is likely that you have had a reactive tendinopathy in the past and not even known about it!
Within this reactive stage if overall loads are adequately reduced and the tendon placed into the correct environment then there is potential that the affected fibres can regenerate and return to their normal state
Increased nerve growth can lead to an increased number of pain receptors. Whilst increased blood vessels can lead to excessive inflammation and a high number of chemicals in the extra cellular matrix that can induce pain.
These processes may be why a tendon can seemingly start to become painful for no reason at all!
It is important to note that this degenerative process does not occur in the entire tendon. In fact, you can have individual tendon fibres that are highly degenerated, right next to completely healthy ones!
The Role of Physiotherapy
Our first aim remains the same…. TO GET YOU OUT OF PAIN.
Whilst the reasons for pain from the tendon itself remains unclea,r a person with a tendinopathy may actually have other structures which are causing them pain at the same time. In fact in some cases the tendon itself may not actually be the painful structure at all!
We used to treat all tendons the same way. However, we are now starting to notice that tendons all require different treatments and that certain tendinopathies may have certain structures which are contributing towards pain.
For example in the case of tennis elbow, (affecting the tendon on the outside of the elbow) pain could be coming from the tendon itself, the elbow muscles, the shoulder, the neck, the upper back or the radial nerve (branching out of the neck and running down into the outside of the arm).
As physiotherapist, we have many different ways to reduce the pain you may be experiencing. This would depend upon your presentation, the tendon that is affected and the other structures which may be contributing towards the symptoms you are feeling.
Physiotherapy DOES NOT stop once the pain starts to reduce!
Once pain is under control, our aim switches towards preventing pain reoccurrence, preventing further degeneration and increasing your ability to continue with your normal activities.
Some of this may come from looking at your work environment, the hobbies and sports you do, the way you move and the muscles and joints around the affected tendon
With doughnut theory in mind, it would make sense that we make the remaining health tendon as robust as we can!
A comprehensive approach to tendinopathy is a must for you to reach your full potential and to reduce the chances of further pain or injury. Tendon rehabilitation is so so much more than a massage and some elastic band exercises,
If you have a tendon injury do not get hesitate to get in contact with us today!