What is a tendinopathy?
Overuse tendon injuries or tendinopathy is a highly prevalent condition that affects both athletes and non-athletes. Current research has replaced the term ‘tendinitis’ (inflammation) with tendinopathy (tendon pain and dysfunction), as it’s been found that inflammation does not have a large role in tendon injuries.
Tendinopathy is an overuse tendon injury that occurs when excessive load is applied, resulting in changes in the cellular matrix and structure of the tendon (Cook and Purdam 2013). We now understand that tendons require optimal loading for its health, but overloading the tendon without allowing adequate time for adaptation and recovery is one of the major reasons why symptoms may develop.
The pain is often well localised at the tendon site and is felt due to the compression of the internal and external tendon structure. Pain from a tendinopathy is often worse after exercise or the next day, compared to during exercise.
Types of Tendinopathies
Tendinopathy can present along a spectrum of reactive or degenerative, this can depend on the stage of the injury (Cook & Purdam 2013). Footballers and runners usually present with Achilles, patella or hamstring tendinopathies.
Tendon injuries can also occur in the upper limb in the rotator cuff, biceps and wrist flexors/extensors.
Tendinopathies often occur after a period of relative inactivity (off season or other injury), followed by a period of activities that involve reloading quickly (overload on return to training). Other types of overload include single high intensity training sessions, increasing frequency of training, change in footwear and change in training surface (Cook & Purdam 2013).
Managing Tendinopathies
It is critical that tendon injuries are always assessed and a detailed management plan is put in place, as the most effective treatment is likely to differ significantly between athletes. The plan depends on the stage of the tendinopathy and the load on the tendon that is created by the sport being played. A poorly managed tendinopathy can lead to time away from sport, large partial tears or even tendon rupture, requiring surgery.
Tendon injuries do not respond well to complete rest and must be loaded appropriately to improve (Cook & Purdam 2013). Tendon injury management is likely to involve specific exercises and modifications to training loads and activities. If tendinopathies are diagnosed quickly, then time away from sport may be minimal. This is more difficult with chronic degenerative tendinopathy or partial tears, which may need a longer period of time to undergo rehabilitation.
Physiotherapists are also skilled in diagnosing and treating external factors that may have contributed to the development of a tendinopathy; these include poor foot and hip biomechanics, tight and weak muscles. Addressing these factors helps to reduce the chance of re-occurrence.
If you have any questions or concerns about tendon injuries in sport, please don’t hesitate to chat to one of our Sports Physio’s.
References:
Cook JL & Purdam CR 2011, ‘Is compression load a factor in the development of tendinopathy’, British Journal of Sports Medicine, vol. 26, no.3, pp. 163-168.
Cook JL & Purdam CR 2013, ‘The Challenge of managing tendinopathy in competing athletes’, British Journal of Sports Medicine, vol. 48, no. 7, pp. 506-509.
