The Three Big Misconceptions About Tendinopathies
Overuse injuries such as tendinopathies, especially in the lower limb, are something that we see quite frequently in the clinic.
There are also a lot of misconceptions out there about how to best treat tendinopathy - here are the 3 most common:
Number one - “Complete rest will make it better.”
When dealing with a tendon injury, many people find that they can be painful during and after a training session, and perhaps even for a day or two following exercise. Often the tendon will be stiff and sore, especially first thing in the morning. Then after they start moving around the pain starts to ease off a little bit. This is a really common experience. It then becomes easy to think that if you just rest the tendon completely it will give the injury and the chance to heal.
Sometimes a period of relative rest can be helpful, however this should generally only be for a short period of time because the problem is, once you start resting for too long, the tendon as well as all the surrounding muscles and tissues start to become deconditioned, and actually get weaker. Once the system weakens it will not be able to sustain the same amount of load that it could before, and so can actually become worse.
What we actually want to do is to progressively re-strengthen the tendon and surrounding muscles to a point that the tendon can tolerate without it becoming too painful.
Number two - “I sustained this injury because I was training too much”
Whilst tendinopathy is commonly deemed an overuse injury, in actual fact research has shown that chronic high training loads can actually be injury preventative. What's more likely to lead to these types of injuries is a recent increase or decrease in training volume.
And in fact, there are a number of factors that can predispose you to tendinopathy besides training volume. A recent systematic review (linked below) which investigated risk factors for Achilles tendinopathy found that there may be several factors that play - These include previous injury, decreased strength of the surrounding muscles, abnormal gait patterns, as well as dietary factors such as alcohol consumption.
Number three. I tried Physio, and it didn't help.
Tendon injuries can be extremely challenging to treat and manage, and sometimes physiotherapy isn't the answer. However, the thing about Physio is that it is not simply one form of treatment, but rather a way to help you manage and oversee your recovery. This may sometime include some “hands-on” treatment methods, such as massage, taping or acupuncture, as well as well as establishing a structured progressive rehab programme tailored to the capacity of your particular tendon. And if you’ve tried conservative management and still failed, then your Physio should be able to refer you for further review from a specialist such as a sports physician who may offer another option.
How do you treat tendinopathy?
Evidence based treatment
There is a growing body of evidence that tendinopathies, a group of conditions characterized by tendon pain and stiffness, can be effectively treated with exercise and other physical therapies. In particular, recent studies have shown that tendinopathies of the shoulder, elbow, and Achilles tendons can be effectively treated with a combination of exercises that target the affected tendon and other tissues in the area. These exercises improve blood flow to the tendons allowing for tendon healing, increase range of motion, and reduce pain and stiffness.
A variety of evidence-based treatments are available, and with the help of a qualified healthcare professional, you can develop a plan that will help you heal and get back to your normal activities. So if you're dealing with tendinopathies, don't despair — help is available. Seek out a qualified healthcare professional and start working on a treatment plan to get you back to your old self again.
Everything else...
Extracorporeal shock wave therapy
Extracorporeal shock wave therapy is a new treatment that has shown some promise for treating tendon injuries. During this therapy, sound waves are used to break up and repair damaged tissue and promote tendon healing. There is limited evidence at this time to suggest that extracorporeal shock wave therapy is effective for treating tendinopathies. However, the therapy does have a low risk of side effects and may be worth considering for people who have not had success with traditional treatments.
Corticosteroids
Corticosteroid injections are a common treatment for tendinopathies. The corticosteroids help to reduce inflammation and pain. However, there is limited evidence that corticosteroid injections are effective for tendon healing. The injections may provide some relief in the short-term, but they do not appear to promote healing of the tendons. For this reason, corticosteroid injections are not considered a long-term solution for tendinopathies.
Platelet Rich Plasma (PRP) Injections
Platelet Rich Plasma (PRP) injections have been gaining popularity as a treatment for tendon injuries, but the evidence for their effectiveness is limited. PRP injections are made from a patient's own blood, which is centrifuged to concentrate the platelets. These platelets are then injected into the affected tendon. Theoretically, this should promote healing by providing growth factors and other cytokines to the injured tissue. However, there is currently only low-quality evidence to support this approach. A systematic review of the existing research found that PRP injections may provide short-term pain relief, but there is not enough evidence to determine whether they can improve long-term function. Given the lack of data, patients should discuss the risks and benefits of PRP injections with their healthcare providers before deciding whether or not to undergo this treatment.
Low Level Laser therapy
Low level lasers, also known as cold lasers, are often used to treat tendinopathies, which are common injuries that occur when the tendons become irritated or damaged. While there is some evidence to suggest that low level laser therapy can help to reduce pain and inflammation, the overall evidence for its efficacy is limited. In addition, the long-term effects of low level laser therapy are not yet known. As a result, it is important to speak with a doctor before undergoing this treatment for tendon healing.
Stem Cell Technology
Stem cell technology holds great promise for the treatment of a variety of diseases and injuries. However, there is limited evidence for its efficacy in treating tendinopathies, or chronic tendon injuries. In tendinopathies, the tendons become damaged and inflamed, causing pain and disability. Stem cell therapy involves injecting healthy stem cells into the damaged tissue, in order to promote tendon healing. While there are some small studies that suggest stem cell therapy may be helpful for tendinopathies, larger and more well-designed studies are needed to confirm these findings. Additionally, more research is needed to understand the long-term risks and side effects of stem cell therapy. Given the current state of evidence, stem cell therapy should be considered experimental and should only be done as part of a clinical trial.
Surgery
Surgery has limited evidence for treating tendinopathies when compared to conservative treatment. However, in some cases, surgery may be the only option. For example, if the tendinopathy is the result of an injury, surgery may be necessary to repair the damage. Similarly, if the tendinopathy is the result of a degenerative condition, surgery may be necessary to remove the damaged tissue. In addition, surgery may be recommended for cases that have not responded to conservative treatment. Ultimately, the decision to pursue surgery should be made in consultation with a qualified physician.
Can tendinosis be cured?
There is no single answer to the question of whether or not tendinosis can be cured. The condition is a broad category that includes a variety of different tendinopathies, each of which may have a different prognosis. In general, however, tendinopathies tend to be chronic conditions that take quite a while to resolve. Tendinosis is a complex condition, and there is still much we do not understand about it. As research continues, we may eventually find more effective ways to promote tendon healing and cure tendinosis. Until then, however, patients should work with their healthcare providers to develop a treatment plan that meets their individual needs.
While tendinosis is a chronic condition, there are a number of treatments that can help to reduce pain and improve function. Tendinopathies are typically treated with a combination of physical therapy, icing, and medication. Surgery is rarely required, and most people with tendinosis are able to manage their symptoms with nonsurgical treatments. Early diagnosis and treatment can often help to prevent the condition from becoming worse.
What is the cause of tendinosis?
Biomechanics
One of the main causes of tendinosis is poor biomechanics, leading to tendon degeneration and tendon injury. This refers to the way your joints move when you walk, run, or jump. If you have poor biomechanics, it puts extra stress on your tendons, which can lead to tendinosis. There are several different types of tendinopathies, but they all share one common symptom: pain. The best way to prevent tendinosis is to improve your biomechanics. This can be done by wearing proper shoes, using orthotics, or doing exercises that strengthen the muscles around your joints.
Tendon Overload
Overload is a main cause of tendinosis, tendon degeneration due to overuse. This can happen when tendons are used repeatedly for activities such as typing or playing the piano. The tendons become damaged and weak, eventually leading to tendinosis. Treatment for tendinosis typically involves rest and stretching exercises.
Age-Related Changes
As we age, our tendons become less elastic and more brittle. This makes them more susceptible to injury and tendinosis. Age-related changes are a common cause of tendinosis in the shoulder, elbow, and Achilles tendon. Treatment for age-related tendinosis typically involves physical therapy and medication.
Is tendinopathy permanent?
Tendinopathy is a tendon injury that results from degeneration or overuse. It can cause pain, stiffness, and weakness in the affected area. The good news is that tendinopathy is often treatable with rest, ice, and physical therapy. However, the bad news is that it can sometimes be a chronic condition that leads to long-term pain and disability. The best way to avoid tendinopathy is to be careful not to overuse your tendon during activities. If you do experience tendon pain, be sure to see a doctor so that you can receive proper treatment.
Common Types of Tendinopathies:
Achilles Tendinopathy
The Achilles tendon is a strong band of tissue that connects the calf muscle to the heel bone. It’s used with every step we take, so it’s no wonder that it’s a common site of injury. When the Achilles tendon is damaged, it’s called Achilles tendinopathy. This condition can be caused by overuse, repetitive stress, or a sudden increase in activity. It can also be a result of an underlying medical condition, such as rheumatoid arthritis or gout. Symptoms of Achilles tendinopathy include pain and stiffness around the Achilles tendon, as well as swelling and tenderness. The good news is that Achilles tendinopathy is treatable. Physical therapy and a graduated exercise program
Rotator Cuff Tendinopathy
The rotator cuff is a group of muscles and tendons that surround the shoulder joint. These structures help to lift the arm and stabilize the shoulder joint. Rotator cuff tendinopathy is a condition that occurs when these muscles and tendons become irritated or inflamed. Rotator cuff tendinopathy can be caused by overuse, injury, or age-related degeneration. Symptoms of rotator cuff tendinopathy include pain, stiffness, and weakness in the shoulder. Treatment for rotator cuff tendinopathy typically includes rest, ice, and physical therapy. Surgery is sometimes necessary if the rotator cuff is severely damaged.
Lateral epicondylitis
Lateral epicondylitis is a condition that causes pain on the outside of the elbow. It's also known as "tennis elbow" because it's common among tennis players. The condition is caused by overuse of the muscles and tendons in the forearm. This can happen from repetitive motions, such as swinging a racket or hitting a ball, resulting in tendon injury.
The symptoms of lateral epicondylitis include pain and tenderness on the outside of the elbow, weakness in the forearm muscles, and difficulty extending the arm fully. The best way to treat lateral epicondylitis and allow tendon healing is to rest the injured arm and avoid activities that aggravate the symptoms. Physical therapy and stretching exercises may also be recommended. Surgery is rarely necessary.
While tendinopathies can be painful and debilitating, it’s important to remember that they are often treatable with conservative methods such as rest, ice, and physical therapy. If you think you may be suffering from a tendinopathy, be sure to see a physiotherapist so that you can receive an accurate diagnosis and treatment plan.
Patella Tendinopathy
Patella Tendinopathy is a tendon injury that results from the overuse of the patellar tendon, which connect the kneecap to the shinbone. The patellar tendon helps to extend the leg, and is used when we jump, run, or climb stairs. Patella Tendinopathy can occur when the tendon is placed under too much stress, causing it to become inflamed and painful. The condition is most common among athletes who participate in high-impact sports such as basketball or football. Patella Tendinopathy can also be caused by repetitive motions such as running or cycling. Symptoms of Patella Tendinopathy include pain around the kneecap, tenderness, and stiffness. The good news is that Patella Tendinopathy is treatable. Physical therapy, stretching, and strengthening exercises are often recommended. Surgery is rarely necessary.
Are you experiencing tendon pain? If so, please consult a physician. Early diagnosis and treatment is key to preventing the injury from becoming chronic. In the meantime, be sure to take care of your tendons by following the tips we’ve provided in this blog post. We hope they help you get back to your everyday activities as quickly as possible.
References:
Clinical risk factors for Achilles tendinopathy: a systematic review
https://bjsm.bmj.com/content/53/21/1352
The training—injury prevention paradox: should athletes be training smarter and harder?:
