Tendinopathy is a an umbrella term used to describe diseases the effect the tendons within our bodies.
The following are some knowledge bombs from Peter Malliaras – a physio from Melbourne who is heavily involved in tendon research and treatment.
Complete rest does not help a tendinopathy, don’t stop sport, but seek guidance from a physio to manage your training load
The ‘inflammation’ that occurs in some tendinopathy is not what you’d think of typically as ‘inflammation’. With tendinopathy at times there are inflammatory markers, biochemical cells that are the precursor to inflammation, bit without the true swelling, redness and so on seen in say a sprained ankle.
The biggest cause of tendinopathies is a sudden change in training load (starting a new season, new years resolutions). The most important thing to realise is that activities which require tendons to ‘store energy’ such as running and jumping as well as activities that compress tendons, will be most aggravating and the biggest causative factors for tendinopathy. This can be caused by poor biomechanics, such as bad sprinting or paddling technique, and can be caused by systemic factors such as age, immune issues, blood sugar levels and even menopause.
The single best treatment that is supported by research is ‘exercise’. Tendons like being loaded progressively – think about building their tolerance like a savings account. In most cases tendinopathy will not improve without exercise.
Load modification is essential – reducing the occurrence of the above aggravating factors with your physio will be crucial
Pathology on imaging is NOT equal to pain – pathology is common in people without pain. Also, if you have been told you have ‘severe pathology’ or even ‘tears’ this DOES NOT necessarily mean you will not get better or have a poorer outcome. Further, we know that even with the best intentioned treatment (exercise, injections, etc) the pathology is not likely to reverse in most cases. Therefore, most treatments are targeted towards improving pain and function, rather than tissue healing, although this still is a consideration
Tendinopathy rarely improves long term with only passive treatments such as massage, therapeutic ultrasound, injections, shock-wave therapy etc. Exercise is often the vital ingredient and passive treatments are adjuncts. Multiple injections in particular should be avoided, as this is often associated with a poorer outcome
Exercise needs to be individualised. This is based on the individual’s pain and function presentation. There should be progressive increase in load to enable restoration of goal function whilst respecting pain
Tendinopathy responds very slowly to exercise. You need to have patience, ensure that exercise is correct and progressed appropriately, and try and resist the common temptation to accept ‘short cuts’ like injections and surgery.
There are often no short cuts.