Tendon Pain

Understanding Tendon Injuries

Tendon injuries include tendonitis, tendinopathy, and tendinosis. Injury or pathology can affect any tendon in the body. These injuries typically occur in one of three areas: the musculotendinous junction (where the tendon meets the muscle), the mid- portion of a tendon (non-insertional tendinopathy), or at the point where the tendon inserts into bone.

Tendon Overview

Tendonitis (or tendinitis) refers to ‘inflammation’ of the tendon, though true inflammation is rare. The term is often used out of habit. The most common tendon injury, however, is tendinosis, a change in the internal structure of a tendon where overloading causes the collagen in the tendon to break down. Tendinosis does not respond well to anti-inflammatory treatments but can be effectively managed with rehabilitation.

Most tendon injuries are the result of overload, overuse or aging. Tendons are designed to withstand high, repetitive loads, but when the stress becomes too great, small micro-injury can form. If these areas are not given time to heal, the injury progresses, leading to tendinopathy or tendinosis.

Tendinosis typically presents as pain, stiffness, and loss of strength in the affected tendon. The pain often worsens with use and may be more intense in the morning or at night. The area around the tendon may be swollen, tender, or thickened, and you may notice a “crunchy” sound or sensation when moving it.

Tendinosis progresses through four phases. In the initial phase, called reactive tendinosis, the tissue is still adapting to the load and the prognosis for recovery is excellent. In tendon dysrepair, the injury exceeds the rate of repair, and while healing is still possible, it’s essential to prevent further progression. Degenerative tendinosis involves cell death, with a poor prognosis as the tendon cells begin to give up. Finally, a tendon rupture signifies catastrophic tissue breakdown, often requiring surgery.

Diagnosis of a tendon injury typically involves a physiotherapist assessing your symptoms, physical condition, and exercise routine. In more severe cases, diagnostic imaging such as an ultrasound or MRI may be utilised to confirm the extent of the injury.

Tendon Treatment

Treatment for tendinosis usually begins with modifying your activities. Modified activity and exercise is more beneficial to promote recovery compared against resting. A progressive strengthening program, designed to improve tendon function, is vital. This will include heavy resistance exercise with progression to plyometric exercise. Plyometric exercises utilise the stretch-shortening cycle, where muscles rapidly lengthen (stretch) followed by an immediate contraction, to enhance power, speed, and strength. Your physiotherapist will assess you and help advise and manage the load on the injured tendon.

Final Thoughts

Returning to activity after a tendon injury can take several weeks or typically months, and it is important to be patient. To avoid re-injury, you may need to make changes to your activity or exercise technique, incorporate exercises, and closely monitor your exercise loads. Persistent tendon injuries are best managed by a physiotherapist. Tendons respond differently than muscle injuries and therefore an accurate diagnosis and targeted rehabilitation is key to recovery.