Tendinopathy

What is tendinopathy?

The term ‘tendinopathy’ refers to a condition that affects tendons, which are tough, fibrous tissues that connect muscles to bones. It is a general term used to describe a disorder characterised by pain, inflammation, and impaired function. Tendinopathy can occur in different parts of the body, commonly affecting tendons in the shoulders, elbows, wrists, hips, knees, and ankles.

There are typically two stages in a tendinopathy:

  • Tendonitis: This is the earliest stage and refers to acute inflammation of a tendon, usually caused by overuse, injury, or repetitive motion. It often occurs as a result of sudden or excessive strain, leading to pain, swelling, and tenderness.
  • Tendinosis: If a tendonitis is not allowed to settle then a more persisting injury occurs which is characterised by degeneration, micro-tears, and structural changes within the tendon. Unlike tendinitis, tendinosis does not involve significant inflammation. Instead, it involves a failed healing response, with the breakdown of collagen fibres and the accumulation of disorganised tissue.

What causes tendinopathy?

Tendons may be injured by various factors, including:

  • Overuse or repetitive motions: Engaging in activities that involve repetitive movements or excessive strain on a particular tendon can lead to tendinopathy. This is common in sports that require repetitive motions, such as tennis, running, or weightlifting.
  • Ageing: Tendons naturally become less flexible and resilient with age, increasing the risk of tendinopathy.
  • Poor biomechanics: Issues with posture, body mechanics, or abnormal joint alignment can place excessive stress on tendons, leading to tendinopathy.
  • Poor blood supply: Certain tendons have limited blood supply, making them more prone to degeneration and slow healing.
  • Previous injuries: Tendons that have been previously injured or weakened are more susceptible to developing tendinopathy.

What are the symptoms of tendinopathy?

The symptoms ocan vary but commonly include:

  • Pain and tenderness in the affected tendon, often worsening with activity or movement.
  • Stiffness and reduced range of motion.
  • Swelling or thickening of the tendon.

How is tendinopathy treated?

Treatments typically consist of non-surgical measures, such as:

  • Rest and activity modification: Reducing or avoiding activities that aggravate the symptoms, allowing healing.
  • Physical therapy: Specific exercises and stretches can help strengthen the tendon and improve flexibility.
  • Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain-relieving medications may be used to manage pain and inflammation.
  • Application of ice: Cold therapy (ice packs) can help reduce inflammation in the early tendonitis phase
  • Shockwave therapy: Shockwave therapy can be beneficial in certain cases of tendinopathy.
  • Orthotic devices: The use of braces, splints, or orthotic inserts may provide support and alleviate stress on the affected tendon.
  • Corticosteroid injections: In some very occasional cases, the specialist may recommend injecting corticosteroids around the tendon to reduce inflammation and pain. However, these injections are generally used sparingly due to the potential risk of tendon weakening as well as being less effective in the later stage of the condition.