TENDINOPATHIES

WHAT IS TENDINOPATHY?

Tendons are collagen proteins that are strong tissues that have a rope-like appearance and are responsible for connecting muscles to bones to allow activation of movement at a particular joint. Usually occurs from repetitive overloading activities that cause breakdown of the collagen tissues causing pain and limitation of function. 

Any tendons in the body can have tendinopathy but the most common areas are the achilles tendon, rotator cuff tendons, patellar and hamstring tendons. 

Who is most likely to get tendinopathy?

It can happen to people of all ages particularly people who perform repetitive overhead movements such as tradesmen or athletes. It can also affect individuals who have suddenly started a new activity and their loading and repetitive nature of practicing that activity can cause a reaction to an already worn out tendon (in the elderly) or to an overworked tendon (youth). 

What causes it?

Most commonly caused by sudden stress/overloading or over use on a tendon. Aging and the associated loss of muscle tone can also play a role in the development of tendinopathy.

How does physiotherapy help?

Physiotherapists can help right from the beginning when you experience pain to maintain muscle strength and continue gently stimulating the tendon aiding in healing. We can then continue supporting you to rebuild strength levels back in a progressive manner back to your level before your injury. Exercise therapy and education around the activities to avoid and manage are crucial to getting back to normal activities effectively. More information can be seen in the blog tendon talk and booking in to see one of our physios to get you going again.

Pathophysiology 

Tendons are a strong band like fibrous connective tissue that allows muscles to connect to bones and is responsible for withstanding high levels of tension when a muscular contraction is generated. Tendons become pathological when the mechanical repetitive tensile load triggers a physiological response within the tendon linked to an imbalance of catabolic and anabolic processes of the tendon.This imbalance causes a failure in the tendon to adapt and regulate the tenocyte behaviour of the tendon reducing the load bearing capacity and reducing the tendon to lower tensile loading as a result of this disruption. 

Recent research shows that tendons can go through a continuum known as the reactive, disrepair and degenerative stages of tendinopathy. Intrinsic and extrinsic factors can contribute to the optimised load and adaptation a tendon needs to go through to move up and down through the different stages to return to a normally functioning tendon. 

Lateral hip pain was previously thought to be caused by the trochanteric bursa commonly affecting females over the age of 50 years old. However recent radiological and surgical studies have shown that non inflammatory markers and signs are actually caused from tendons of the gluteus medius/minimus muscles as the main source of lateral hip pain. 

Prevalence - most common cause of lateral hip pain 

 The prevalence of gluteal tendinopathy is common among post-menopausal women, those with associated lower back pain as well as lateral gluteal pain is as high as 35% due to the weakness and dysfunction/disorder of the muscle to reduce lateral pelvic stability and or atrophy/deconditioned individuals returning to activities/sports again. 

Tendinopathy treatment approaches centres around education on load management and addressing modifiable risk factors to reduce pain and encourage exercise therapy as a method of gradually and progressive reloading the tendon back to normal function. 

Treatment outcomes

Education along with exercise has been shown to be the most effective and better approach in managing/reducing lateral hip pain, improved functional outcome, quality of life and self efficacy are achieved for each individual that presents with lateral hip pain caused by tendinopathy up to 52 weeks after the 8 week training programme compared to corticosteroid injection.

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