Tendons are bands of tissue that attach our muscles to bones. One well-known example is the Achilles tendon: it’s the largest tendon in the body and connects the calf muscle to the heel bone. Tendons have some ability to stretch (as they are made in part of collagen), but their main function is resisting tensile forces.
Tendinopathy is a generic descriptor, thought to be a failed or “abnormal” healing response within the tendon itself, and is usually associated with overuse in and around the tendon. Tendinopathies most commonly affect the wrists, shoulders, knees, and ankles and are usually associated with symptoms of pain, swelling, and loss of function.
What causes tendinopathy?
There are many different risk factors that could lead to the development of a tendinopathy. The most common factor is a sudden change in activity, either the type (e.g. walking, running, and jumping that require a tendon to store more energy) or load (that requires more tendon compression). Other risk factors could include an individual’s biomechanics (e.g. poor muscle capacity or endurance) or systemic factors (e.g. age, menopause, increased susceptibility to pain).
Even though there can be some swelling present with tendinopathy, it isn’t considered a classic inflammatory response (like in an acute injury). As a result, tendinopathy will not improve with rest (and ice). Of course rest may settle the pain experienced, but as soon as you return to activity, the pain will return because resting does nothing to increase a tendon’s tolerance to load.
So what is the best way to treat a tendinopathy you ask? The answer mainly lies in loading the tendon, a.k.a exercising in the form of strength training, below the threshold of pain. Loading the tendon progressively allows it to develop a greater tolerance to the loads required to endure day-to-day activity. It is important to note that this also means that overaggressive exercise won’t help either. This is where having a physiotherapist comes in handy–we can guide you through an appropriate exercise program to help with your long-term recovery, as well as provide more passive, hands-on treatments for shorter-term relief. These more passive treatments can include, but aren’t limited to, manual therapy, soft tissue release techniques, shockwave therapy, acupuncture, etc.
Isometric shoulder abduction exercise (above left) and eccentric calf exercises
In early rehabilitation, physiotherapists modify load (short-term) so that tendon pain can settle. At this point your exercise program will likely consist of isometric exercises (contracting the muscle without changing its length), which can help decrease pain. The program would progress to eccentric exercises (working the muscle as it’s lengthening, otherwise known as a “negative”). Eccentrics have been thought to stimulate healing and help with the remodeling of collagen in the tendon. This progressive loading process would occur in response to tolerance and perceived pain ratings.
It is crucial to note that tendinopathy responds very slowly to exercise, so patience is key! Try to resist the urge to seek out the “quick fix” like injections and surgery–like most of life, there are often no shortcuts.
Note: Injections, such as corticosteroids improve short-term outcomes but have been shown to be worse than no intervention or physiotherapy for immediate- and long-term outcomes for some types of tendinopathy. However, in some cases using injections as adjuncts to tendon loading can be beneficial in the management of tendinopathy.
If you would like more information with regards to the research supporting the above, please feel free to contact me.
For more information or to book an appointment call 705-380-3312 or visit the website. Surge Physiotherapy is located at 33 King William Street, Suite 204, in Huntsville. Office hours are flexible with evening appointments available (three times per week). Email: email@example.com.
Stephanie Bourbeau is a bilingual, Registered Physiotherapist with the College of Physiotherapist of Ontario and the Canadian Physiotherapy Association who is committed to providing a hands on, personalized approach to physiotherapy.
Stephanie, a native to the Huntsville community, developed a passion for health and wellness during her youth while competing in cross-country running, nordic skiing, and track and field. Stephanie has always had a strong caring nature and fell in love with the physiotherapy profession while volunteering at a physiotherapy clinic during high school and university.
Stephanie continued to build on her passion for health care by attending McGill University and completing her Bachelors of Science in Kinesiology. During her Masters in Health Science of Physiotherapy, completed at the University of Ottawa, she completed internships in orthopaedic clinics, hospitals, home care, and neurology centres.