Top tips for treating tendonitis and tendinopathy

Runners love to run

Painful tendons are a common complaint for everyone at some point in time. They are not solely the domain of athletes or regular gym goers. At some point we may get a niggling pain in our achilles , shoulder or elbow that is telling us we have a grumpy tendon developing.

These painful tendons are referred to as tendonitis, tendiniosis and now the more commonly used term tendinopathy. Essentially these are are terms used to describe a painful tendon that has developed due to a mismatch between how much we are asking it to do and how much it can actually do.

Here are our top tips for treating tendons

  • Do not ignore your pain if you have tendonitis or tendinopathy
  • Don’t go for complete rest, Modifying activity is the best option
  • Don’t let the tendon forget its job, Start strengthening early as possible.
  • Build up the tendons fitness , get it stronger and fitter for what you need it to do.
  •  Get your tendon assessed.

Ain’t nothing wrong with getting the tendon strong.

What is a tendon and what does it do ?

Tendons are more than just the attachment of the muscle to the bone, although this is an important function allowing movement at a joint.

They are highly specialised tissue made of a protein known as collagen that have the ability to store energy and act like a spring to release that energy. The best example of this is watching kangaroos hop !

Why causes tendinopathy ?

This is a difficult question to answer as it differs  between individuals depending on their lifestyle factors, activity levels , underlying health conditions as well as the strength and flexibility of the tendon and its surrounding structures.

Reactive tendinopathy  is the fancy term for when a tendon becomes painful.

It is usually a reversible process and is a result of a sudden change in demands placed on the tendon.

It typically involves the tendon responding to a rapid increase in loading. For runners this often means a large increase in mileage, a reduction of rest days or a change in training type (e.g. Introducing hill or speed work).

For others it may be the result of increasing walking distance suddenly  such as going on holiday and sightseeing. Or starting a new sport or exercise after a period of doing nothing. Returning to pre season training for netball and suddenly jumping and landing again.

It can also be from direct trauma to a tendon.

Tendinopathy Risk factors include:

  • Sudden increases in activity or adding a new activity:
  • Walking 10,000 steps a day from 2000 steps.
  • sudden spikes in loading in athletes training program are related to an increase in injury rate.
  • Individuals returning to pre season after doing very little conditioning.
  • Taking up  a sport  after a long year break…. Masters athletes.

Underlying health conditions:

  • Diabetes the increased blood sugar level  affects the tendon by making the collagen too stiff.
  • Link with cholesterol levels as a risk factor.
  • Hormonal. Oestrogen increases the risk of injury in tendon by affecting collagen quality.
  • Rheumatoid conditions.
  • Tendons are more vulnerable due to anatomical location causing more compression:
tendon compression sites

So what’s the best treatment for tendonitis or tendinopathy ?

Not all tendinopathies  or tendons are created equal so it will differ between individuals. On their own the likes of TENs machines, ultrasound etc are effectively useless. At best they will offer temporary relief of symptoms but won’t improve the strength of the tissue

Also evidence from the past few years indicates that this type of pain is not related to inflammation and as such traditional treatments aimed at controlling inflammation such as corticosteroid injections and nonsteroidal anti-inflammatory medications (NSAIDS) may not be the most effective option.

So we have put the the following rules are a brilliant framework to get started on:

Rule 1: Do not ignore your pain if you have tendonitis or tendinopathy.

Pain is telling you that you need to change. It’s an indication that the tendon is not fit enough to cope with your current activity .

Unless in very acute or painful situations don’t completely rest, this is probably especially true for lower limb tendons such as the achilles, plantar fascia or tendons around the knee. It’s far better to work out how much weight bearing or load it can take without flaring it up as this keeps the collagen strong and “reminds” the tendon of its job that it needs to keep doing.

Rule 2.

Don’t go for complete rest with tendonopathy or tendonitis , Modifying activity is the best option

Most tendon issues are due to a lack of “tissue fitness”. We need to get them stronger to tolerate and absorb force.

We don’t want to completely unload the tendon but we may want to offload it to help the tissue calm down and get lass angry but still do enough work / exercise to create nice healthy strong collagen.

In the early stages its a case of taking 1 step back to move 3 steps forwards.

This can be as simple as

  • identifying and stopping aggravating postures or activities.
  • reducing training volume.
  • adapting exercises to suit your symptoms.
  • using more appropriate footwear
  • taping, ice or NSAIDs

Once the pain has settled then we can really get down to the business of getting a healthy tendon back.

Rule 3.Don’t let the tendon forget its job, Start strengthening early as possible.

Tendons are the body springs ,structures that are designed to absorb load and release load. To do this they need to have the strength to do this as such we want to start building the strength of the tendon back as quickly as possible.

This can be as simple as static isometric exercises in the early stage or assisted active strength exercises.

Rule 4.

With tendinopathy/tendinitis, get the tendon stronger and fitter for what you need it to do.

how tendon responds to strength training

Most tendons need to build up their tissue fitness to cope with the demands of daily life or sporting endevours.

A mix of static, heavy load and eccentric exercises work best, and they need to be made progressively harder and more specific every 4 weeks.

It is best to do one or two days on followed by a day of rest when loading the tendon to allow it to recover, adapt and get stronger.

A really good example of this is the protocol we use for treating Achilles tendons and plantar fascia.

Tendons are a bit slower in getting stronger than muscle so even once you are painfree you still need to keep topping up the strength work to keep it healthy and strong. As a rule of thumb it takes about 3 months to increase the strength of a healthy tendon. Your symptoms will improve well before this in most cases, but you have to work over a long period of time to get it back to its optimal state.

I can hear the groan of disappointment already however here’s a reason to celebrate. Once the tendon is settled and not impacting your activity you may only need to do something as simple as 2 minutes of exercise a day !

welcome to the world of  ramping isometrics for tendon

Rule 5.  Get your tendon assessed

Possibly the most important rule is the last one, get it assessed and take the guess work out of your path to recovery. Often its the best way to identify;

  • what is causing the issue with your tendon.
  • what you activities you can modify or stop doing in the short term to help with the pain.
  • what exercises you can start with and how we want to progress them.
  • What manual therapy or mobility exercises you need to work on.

Also we can see if Shockwave can be helpful as an adjunct to help reduce pain and “kick start the repair process,  in conjunction with a strength based exercise protocol.

P.s  did you know you can feed a tendon for better health? you can find out more here.

If you have any tendon related problems you can book in here to see one of very experienced clinicians


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