March 20, 2019 at 2:58 PM
When we have time off of being active it’s tempting to jump straight back in where we left off: a 5k run on the beach on day one, a hard training session after a restful off-season, a long hike after sitting at a desk for months. Afterwards, you experience pain but after some more time off you think the problem has gone away, only for it to return again with activity. Maybe you ice it, stretch, take more time off but the pain always returns with activity. You may spend months on this merry-go-round. Distressed you wonder ‘why isn’t it getting better?!’
If this sounds like you, it’s possible you have developed a tendinopathy.
Tendinopathy or tendinosis are terms describing a pathology of the tendon characterized by pain, impaired function and changes in the composition of the tendon at a cellular level. Less commonly used is the old term tendinitis. Itis is a Greek or Latin suffix used in medicine to describe an inflammatory condition. We no longer use this term as we now understand that any inflammation present in tendinopathy is not the primary driver of pain and impaired function. It is also why the treatment for inflammation (i.e. rest, anti-inflammatories and ice) does not effectively treat tendinopathy. Instead, tendinopathy requires strengthening in order to address the underlying structural changes at a cellular level.
You might be wondering why this pain has started now? In short, tendons don’t like dramatic changes in load - this means too much or too little load! So if you’re just getting back into sport or starting something new, start slow. Tendinopathy tends to affect those over 40 years of age but is not restricted to athletes alone. Women, either while pregnant or around menopause, are also at increased risk of developing tendinopathy due to hormonal changes. Even putting weight on over a period of time and returning to an activity can significantly increase the load on your tendons.
Common sites for tendinopathy include:
- Elbow (also known as tennis or golfers’ elbow)
- Hip (common in women during pregnancy or menopause)
- Knee (usually in young athletic men in sports involving a lot of jumping)
Some Interesting Facts
Did you know that the amount of pain you feel is not linked to the severity of your injury? Research has shown that people in lots of pain can have minimal changes in the tendon seen on imaging and people with enough damage to lead to complete rupture of the tendon have reported no pain just prior to tendon failure. The take-home message is that you cannot rely on your pain to determine how bad it is.
Your rehabilitation is likely to be more successful if you focus on getting your tendon as strong as you can and place less focus on the cellular changes that have taken place. Just remember it is possible to regain function and eliminate pain by strengthening. So best keep a positive mindset and don’t place too much stock on any bad news from your ultrasound report.
Strengthening is not straightforward as it sounds: loading your tendon too much or too little will cause you to remain on the pain-rest-activity-pain merry-go-round. A physiotherapist is best suited to tailor a program for you that will incrementally increase your load tolerance and effectively treat your pain.
An appropriately prescribed exercise called isometric strengthening can significantly reduce your pain immediately and be an important element of your rehabilitation program.
Tendinopathy cannot be treated effectively with only ice and a little rest and the longer you leave getting treatment, the longer it will likely take to resolve.
Lastly, stretching your tight painful tendon may be inhibiting your recovery. It is best to get properly diagnosed so that you know what will help and what won’t.
Treating tendinopathy is all about balancing the right amount of load and gradually increasing strength over weeks to months without exceeding the threshold limit that your tendon can withstand at any point. A physiotherapist knows when to push you further despite pain, and when to hold back and maintain a more cautious approach to increasing your activity. Your physiotherapist will help you to understand this so you can get better as soon as possible.
Physiotherapists use a combination of well-researched exercises and experience in tailoring an independent exercise program for you that will incrementally load the affected tendon. The exercise must be specific so that it will isolate load through the affected tendon in a graded fashion while considering other loading factors that may be contributing to the overall condition of your tendon. It’s not just as easy as making you stronger because not all loading is considered equal.
Physiotherapists have a very good understanding of good versus bad loading. Good loading helps to strengthen the healthy tendon thus reducing your pain and improving your function. Bad or abusive loading may include high loads, repetitive low loads or compressive forces on the tendon leading to increased pain and impaired function. Tendons can be compressed in certain sitting positions, sleeping positions, certain footwear or clothing. There are a lot of factors to consider but a physiotherapist can help to identify the potential bad loads in your life helping you to a speedier recovery.
Recovery from tendinopathy can take weeks to months and will likely involve a few setbacks as you work with your physiotherapist to find just the right load progression and activity modifications to get you back to 100%. It requires patience, diligence with your exercises and avoidance of aggravating factors. It’s a road to recovery that shouldn’t be taken alone. If you think you may be suffering on the pain-rest-activity-pain merry-go-round, don’t hesitate to give us a call today to be properly diagnosed and begin your road to recovery.
Robyn is a Masters Physiotherapist, with expert experience in postural syndromes and tendon pain. To book an appointment with Robyn click here.