Tendinopathy is an umbrella term used to describe any
pathology of the tendons. You may have
heard it referred to by many different names:
tendinitis, tendinosis or tenosynovitis.
Some common tendinopathies include achilles, patella, common wrist
extensor and biceps. Whichever type, and
whatever the location, tendinopathy can manifest as significant pain and cause
a reduction in function. Here are some
basic "Do's" and "Don'ts" to ensure you can overcome your tendinopathy as quickly
- See a healthcare professional, such as a sports physician or physio. They will correctly diagnose the issue, and give you an appropriate treatment and management plan. Not all pain around joints will be tendon related, so it's important to be have the correct diagnosis to ensure you're not potentially making a different issue worse.
- Manage your physical workload. Most tendinopathies are caused by a sudden change in activities (usually an increase). This pertains particularly to activities that load or compress the tendon (e.g. walking/running for Achilles tendinopathy). Generally high velocity movements (fast loading/movement through the joints) tends to be the most aggravating factors, so consider any new activities which you have introduced to your day to day life.
- Reduce load initially. You want to continue with your normal exercise routine, however decrease the duration and/or intensity. This will help reduce pain, and then you can being to work back towards your normal activity levels.
- Use passive treatments initially for pain modulation. Note that these passive treatments (such as ultrasound, shockwave, injections) rarely help long term, and should only be an adjunct to exercise therapy. Multiple injections should be particularly avoided as these provide poorer outcomes according to current research.
- Use an individualised, progressive loading regime. While the initial stages of rehabmay be similar for most people, it's important to have your program tailored to your own goals in regrds to activity and/or sport once you begin to reduce your pain and increase your function.
- Have patience! Tendinopathies are very slow to progress, even with appropriate exercises. Ensure that the exercises are correct, and that you are adequately progressing the load to attain the best outcome.
- Rely on passive modalities as the sole treatment for your issues long term. While soft tissue massage, dry needling, or other modalities can help reduce the soreness in the short term, they won't help to resolve the underlying issue.
- Stress about imaging findings. We know that imaging findings do not correlate well with pain and function. The management program should be based on returning you to your former function with respect to your current level of pain, and not on how the tendon itself appears under imaging.
- Continue to train normally. This may only serve to prolong recovery if you continue to aggravate the tendon further. Look to reduce load initially, then gradually increase.
- Rest completely. Whilst an initial reduction in loads is recommended, this does not mean complete rest! It is important to maintain function wherever possible. While complete rest may help with pain, when you begin to load through the tendon again the pain can often return, potentially with a greater severity than there was initially.
- Get frustrated that you aren't 100% better within a month. Tendon healing takes time, so make sure you are adequately progressing your loading exercises! Compared to recovering from a muscle strain or joint sprain, tendinopathy resolution is typically much slower due to the differences in the types of tissue.
- Forget about biomechanical factors. Your physio/podiatrist/sports physician should be able to help you address any biomechanical risk factors that you possess that are causing a spike in load through the tendons, and ensure that the issue does not resurface in the future.