What is tendinopathy and what can I do about it?
Tendinopathy is a painful condition that affects tendons (tissues that connect muscles to bones) and is generally due to overuse or what is termed a repetitive strain injury. Tendons are made up of collagen fibres and elastin (a stretchy type of collagen) which gives tendons their elastic properties. Tendinopathy used to be called ‘tendinitis’, however, the suffix ‘itis’ means inflammation. Recent studies where a biopsy of a sore tendon was examined failed to show any chemical biomarkers of inflammation, therefore a name change was required and the current term ‘tendinopathy’ was adopted, which means disease or condition of a tendon; it is a degenerative condition of the tendon.
Tendinopathies generally do not occur after a single insult or incident, although they can. They tend to occur after a sudden increase in load volume, a good example is when a relatively unfit (sedentary) person decides they want to get fit and embarks on a five day a week training regime that involves 100 squats per day. Even though I admire the enthusiasm, this is not a very smart approach to training because it will likely result in tendinopathy. The reality is that tendons have a limited capacity to do work, exceed that capacity and you will run into problems. Tendons take time to adapt to load, a few studies have shown that for the average adult a tendon can only increase its load volume by approximately 10% per week. Which means, that in order to avoid getting patellar tendinopathy if you’ve been performing 100 squats per week last week, then this week you can perform 110 squats without exceeding the patellar tendons capacity. Perform more than 110 squats this week and the risk of getting tendinopathy increases, and the more you exceed that capacity the greater the risk (i.e. doing 200 squats would carry a much higher risk of developing patellar tendinopathy then doing 120 squats). This is what we call load management, which is how we calculate how to increase someone’s load without increasing their risk of tendinopathy. Elite sports teams throughout the world are now utilising load management tools (complicated algorithms) to figure out how much to give athletes and when to give a day off for recovery, which has resulted in far fewer overuse injuries.
Now you know how to avoid getting tendinopathy, but let’s pretend you hadn’t read this blog and you unfortunately managed to end up with tendinopathy. How do you fix it? Well, there are really two questions here. ‘How does a practitioner fix it?’ And ‘How do you - the person with tendinopathy - fix it? These are complicated question as every case is somewhat different and will require subtle changes to the prescribed treatment and rehabilitation programs. However, here are some general guidelines to follow.
Figure out which activity (load) is causing or exacerbating the problem
Avoid or at least minimise the problem activity/movement (short term)
Find alternative ways to perform the aggravating activity/movement in a way that loads the tendon in a pain free or less painful manner
Learn exercises that will strengthen the tendon and/or areas that will affect the tendon
Get some manual therapy (soft-tissue work, shock wave therapy, dry needling)
Here is a made-up example with answers to all the above questions.
The good news is tendinopathy is a very treatable condition and can often be fully remedied. The bad news is that it takes a while to resolve (anywhere from 3-9 months) even if you do all the right things. However, during the 3-9-month recovery period, you should experience fewer and fewer painful days. A common pitfall is that on the days people feel good (pain free) they tend to overdue things physically, which sets off the tendinopathy and if becomes irritated (painful) again for a couple days. So, try to avoid the common mistake and trust the process, it will get better, just be patient. Once the condition is at least 80% better, then you can slowly and gradually increase your physical volume and get back to your normal levels of activity without flaring up your tendinopathy.
I hope this has shed some light on this complex condition. I look forward to sharing more information with you in the future. If you have any questions or concerns regarding this blog, please feel free to contact us.
Your’s in health
The Back to Function Team