Tendinopathy



Tendinopathy is inflammation of the tendon, excessive load on the tendon and develop tendon pain.

Tendon situates at each end of a muscle, attach muscle to bone. Tendon is found throughout the body and achilles tendon is the largest tendon in the body.

Tendon: it is very complex structure that connects bone and muscle. The tendon stores and releases high energy like a splinting. It also works as a shock absorption and love being loaded.

Tendon locates in the entire body and each tendon has different feature. Ex.) Achilles tendon and patellar tendon are energy storage while tibialis anterior tendon works as a positional tendon.

Achilles Tendon

Achilles tendon is powerful and stores energy. However, that has different role even in the tendon.

Mid tendon (belly)

Mid tendon (belly) has roles to store energy and release the loads as well as compression loads by thickened plantaris muscle.

Insertion (where attaches to)

This area gets loaded by compression. Ex). Plantaris can affect and compress the insertion of Achilles tendon as you dorsi flex.

Peritendon

Peritendon is the tissue surrounding tendon. This could be affected by excessive dorsi and plantar flexion like a cycling due to friction loads.

Patellar tendon

This is a little different from Achille tendon as there is no friction and compression loads and pathology occurs in insertion of the tendon. Also, pathology is related to the age.

Patellar tendon pathology is likely to occur in younger age (adolescent) whereas Achilles tendon issue could happen at any age. Like Osgood-Schlatter disease happens in younger athletes as the tendon gets stressed too much in developing time.  

Aetiology

The tendon is chronically overloaded leading to micro tears and an inflammatory response.

Causes are

  • muscle imbalance
  • poor biomechanics
  • lack of flexibility
  • degenerative changes in the tendons
  • Activities such as gardening, carpentry, painting, tennis, golf, skiing and baseball pitcher.

Sign and Symptoms

There are four grades of severity

  1. Pain after activity
  2. Pain at the beginning and after activity but disappears during activity
  3. Pain occurs before, during and after activity
  4. Pain with activities of daily living, may interfere with ADL.

*Usually, pain provoked by tendinopathy is localised and loads.

Restricted ROM, stiffness and swollen may be seen

Tendinitis can occur elbow, knee, achilles tendon, shoulder and base of the thumb

Treatment

  • REST
  • NSIDs(non-steroid anti-inflammatory drug)
  • TEMS machine
  • Splints that limit movement and support body regions
  • Surgical repair if tendon is torn
  • ICE
  • Stretching and strengthening exercises

Exercise (For Achilles tendon)

Stage1: Isometric exercise(exercises that focus on when the muscle gets same load through the exercise such as calf raise but no movement and heels of the ground)

Stage2: Strengthen (Calf raise and single leg calf raise)

Stage3: Fast Load (Calf raise on the box or step, jumping and jumping steps)

Stage4: Functional (sports related) ex.) direction change jumping, quick change direction with short sprint

Interesting fact of the tendon

*Strengthen exercises give some pain relief but tendon works as a spring which means tendon gets loaded by only fast and maximum load activity. If the person can tolerate low heavy activity, that may not be tendon issue.

*The tendon tells you next day (24hours after) if the activity is too early stage or too intense to perform. The practitioners and patients need to monitor how the pain goes next day and what activity aggravates.

*Tendon does not have sensory nerve but peripheral.

Contraindication or massage

Always acute condition is contraindicated.

Massage can assist to restore the ROM.

Reference

  1. K M Khan, J L Cook, P Kannus, N Maffulli and S F Bonar Time to abandon the: tendinitis” myth 2002 BMJ 324 (7338):626-627
  2. J L Cook, K M Khan, Z S Kiss, C R Purdam and L Griffiths Prospective imaging study of asymptomatic patellar tendinopathy in elite junior basketball player.  2000 Journal of Ultrasound in Medicine/volume 19, issue 7
  3. Rudavsky A, CookJL and Docking S proximal patellar tendon pathology can develop during adolescence in young ballet dancers-A 2year longitudinal study 2018 Scand J Med Sci Sports 28 (9):2035-2041
  4. Kelsey Lipman, Chenchao Wang, Kang Ting, Chia Soo and Zhong Zheng tendinopathy: Injury, repair, and current exploration 2018 Drug Des Devel ther 12:581-603
  5. Jill Cook Current concepts in tendinopathy rehabilitation https://www.youtube.com/watch?v=-kKzoi8Zrik

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