So you have a Tendinopathy…
Tendons are bands of tissue that join your muscles to your bones. When you contract a muscle it pulls on the tendon, which in turn pulls on the bone causing your joints to move. These tendons deal with a lot of load on a daily basis and usually they are able to tolerate this with minimal issue. ‘Load’ refers to any force that is put transferred through your tendon during activity. For example running puts a lot of load through your Achilles tendon at the back of the heel or jumping puts a lot of load through the tendon below your kneecap. When too much load is placed on a tendon they can ‘react’ and become painful and swollen resulting in what is called tendinopathy. The pain is usually felt 1-2 days after the activity that caused it. If the tendon is continually overloaded in this way the structure of the tendon can begin to breakdown. Eventually if the load on the tendon isn’t reduced there is destruction of areas within the tendon that are irreversible. As tendons are loaded every day through normal activities it is likely that there is some wear that occurs in the tendon as a normal result of ageing.[1]
Management Plan
Everything you need to know about managing your condition
The first priority for your tendinopathy will be to settle down the pain. This will happen by following the guidelines below
1.Relative rest
Avoid the activity that caused the tendinopathy, if the tendon isn’t rested then the tendinopathy will get worse.
Alternatively, if the tendon is is rested completely then this will also limit the tendons ability to fully recover and be able to take full load in the future. Instead, complete lighter loads that don’t flare up the tendon [2]
2.Medications
Your physiotherapist may advise you to take ibuprofen, green tea, fish oil and doxycycline (antibiotics). These medications all work together to prevent the tendon from breaking down and returning it to a normal, pain-free state [3, 4]. Ibuprofen and doxycycline should always be taken under the direction of medical advice and prescriptions may be required. Always follow your doctor and pharmacist advice regarding any medications.
3.Static exercises
Static exercises involve using your muscles and tendons without moving your arm or leg. These exercises help the pain to settle down and prevent any breakdown of the tendon [2, 5, 6].
Once the tendon is settled we need to prevent the tendinopathy from returning as soon as you load it again. To do this the tendon will gradually be loaded with progressively higher loads. This will increase the tendons ability to take load so that it is less likely to react like this in the future.
•Your physiotherapist will teach you the ‘loading exercises’. This exercises will be used to put force or load through your tendon in order for it to adapt and become used to taking loads in the future.
•Each day complete the loading exercise, increasing the load or repetitions every 2-3days as instructed by your physiotherapist
•Score you pain out of 10 each morning using the test taught to you.
•Record your pain score and any extra activities you complete each day in the table provided.
•Return your completed table to your physiotherapist each visit to help them monitor and progress your program.
Your physiotherapist will also look to correct other factors that could of contributed to your tendinopathy. The aim will be to prevent the same problem returning in the future.
Figure 1 – Exercise diary your physiotherapist will provide to fill in and return during your next appointment.
Article by Brenton Egglestone
