Tendinopathies- What You May Not Know
There are lots of different names that often get used in relation to tendon pain, while their meanings indicate what is going on at a scientific level, they are often used as umbrella terms, used differently in different medical professions or misused.
Tendonitis = was once used to describe all tendon pain, the suffix ‘itis’ indicates inflammation. True tendonitis does occur, however is much less common than tendinopathy, it tends to be a more sudden onset of pain due to a large change in load and generally resolves quickly with appropriate treatment.
Tendinosis = this term indicates a non-inflammatory degenerateon of the tendon, often resulting from repetitive micro-traumas. This term is not used as much as tendonitis or tendinopathy
Paratenonitis = some tensions, like the Achilles tendon, are surrounded by a thin sheath, called a paratenon. Paratenonitis occurs when this paratenon becomes inflamed. This is not commonly diagnosed, however as you need a biopsy for a clinical diagnosis.
Tendinopathy = ‘pathy’ indicates disease or disorder. Is the latest term used within physiotherapy to describe a non-inflammatory overuse injury, however some professionals also use this as an umbrella term for tendon pain.
Tendons are engineered according to their function and because of that tendons from different parts of the body have different structure, composition, cell types and metabolism.
Tendinopathies are most commonly caused by excessive loading and tensile strain on the tendon. This often occurs with, a sometimes obvious, but not always, change in activity. It is also thought that compression can play a role in altering the tendon matrix, this isn’t necessarily compression from an outside source (e.g. shoe on achilles tendon) but most commonly from the compression on the tendon from the bone it attaches to. The compression loads tend to be highest when the tendon is lengthened, for this reason, stretching is often ill-advised and massage is recommended if the muscles feel tight.
4 Load reduction Not Rest
While it is important to modify the load of the tendon, complete rest decreases the ability of the tendon to take load. It also affects the muscle attached to the tendon, reducing their strength capacity also. So while you should not ignore the pain as it is which is guiding you on what loads are too much, movement, particularly specific loading of the tendon is important.
While passive treatments (like electrotherapy and ice) may feel good in the short term, they do not address the need to increase the tendons ability to take load. Loading the tenon in a specific tendon protocol is essential for long term pain and functional improvements.
6 Most commonly affected area
The most commonly affected tendons are the rotator cuff (particularly the supraspinatus), biceps tendon, forearm flexor and extensor tendons, patella tendon, achilles and tibialis posterior tendon.