Tendinopathy | Plenty Physiotherapy, Bundoora

Tendinopathy Document 

Tendinopathy is a broad term describing  pain and dysfunction of a tendon,  typically due to overload. It  encompasses what used to be called  tendinitis (inflammation) and tendinosis generation). Current understanding  shows that tendinopathy is primarily a  failed healing response with collagen  disorganisation and neovascularisation  rather than acute inflammation solely.  Common sites: - Achilles tendon - Patellar tendon - Lateral elbow (extensor origin) - Rotator cuff - Gluteal tendons Clinical presentation: - Localised tendon pain, often activity-related - Morning stiffness or “warm-up phenomenon” (improves with activity, returns  after rest)  Can have thickening/swelling of the tendon - Pain on palpation and with resisted loading increases  Contributing Factors: A) High training loads/activity: High training loads and adolescents who  participate in more volumes and intensity of physical activity (such as soccer,  football, running, jumping, sports in general) will cause more strain and  activation of the quadriceps and patella tendon, therefore irritating the tendon created by increased muscle contractions at the growth plate insertion sites as  discussed above.  B) Inadequate recovery: Poor recovery periods between activity, matches or  training sessions will be responsible for higher periods of tension and symptom  irritation without respite to calm down symptoms. This may lead to longer  periods of discomfor as well as increased irritability likelihood.  C) Muscle imbalances: It has been found that having reduced strength or poor  flexibility in the quadriceps muscle (front thigh bone muscle) and hamstrings (back thigh muscles) can be a factor in this condition due to non-optimal knee  biomechanics and poor load distribution.  D) Intrinsic Factors: a. Poor tendon capacity (weakness, previous injury). b. Age-related changes (less collagen turnover, stiffer tendons). c. Systemic issues: diabetes, obesity, metabolic syndromes. E) Extrinsic Factors: a. Training errors (sudden load increase, high volume, poor recovery). b. Repetitive loading without adequate adaptation. c. Poor footwear (for lower-limb tendinopathies). F) Biomechanical a. Weakness in the surrounding kinetic chain (Shoulder, elbow, glutes, quads,  calves). b. Malalignment or altered movement mechanics (leading to poor load  distribution and overload).  Treatment/Management: 1) Load management: Initially minimising/removing aggravating factors and  activities. Load management is crucial, therefore laying out your current  exercise/sports schedule and modifying things such as frequency, duration and  intensity will aid this. It may be that in addition to strength work, low-impact  cardiovascular (CV) activities such as cycling and swimming may be advised so  that secondary regressions of CV fitness is not a resultant.  2) Rehab/Biomechanical alterations: Exercise-based rehab consisting of  strengthening (early isometric exercises) not only the direct structures involved,  but also the sounding tissue, so that overloading of the injured tissue does not  reoccur (share the load in the kinetic chain). Training groups that have underlying  deficits and neuromuscular control above and below this region are also  focused on to help support and improve your biomechanics. A graded return to  full capacity will be integrated throughout your rehab. Manual therapy such as  soft tissue work, dry needling, and shockwave therapy can also help with healing  and pain management.  3) Ice/Medication: Ice, compression, or taping as well as using forms of pain  killers/anti-inflammatories, particularly after the first 48-72 hours (as directed by  your medical professionals), can help manage acute bouts of pain.  ) Referral: In some cases, the injury to a tendon is severe enough to warrant a  referral to a Sports Doctor or Surgeon. This may also be warranted if a tendon is  not responding to conservative options. Other interventions at this point such as  injections may be advised by your doctor.