Title : Tendinopathy
Tendinopathy is classified by localised pain, swelling, and impaired function within a specific tendon. It can be caused by overuse or develop due to degenerative changes in the tendon. The management of tendinopathy should focus on education, load management and exercise regardless of onset. Tendinopathy requires an active treatment approach, excessive rest can negatively impact recovery time
Overuse vs. Degenerative Tendinopathy
Tendinopathy can be categorized into two main types:
- Overuse Tendinopathy: Caused by repetitive mechanical loading, leading to inflammation and microtears in the tendon. It typically affects athletes or individuals engaging in repetitive activities. Tendinopathy will occur when the load being put on the tendon consistently exceeds what the athlete can recover from
- Degenerative Tendinopathy: Occurs due to long-term repetitive strain, leading to tendon degeneration and disorganized tendon structure. This is more common in older individuals or those with chronic stress on the tendon. Patients suffering from diabetes, high BMI or those who smoke are at an increased risk.
Current Best Practices for Conservative Management
1. Load Management
- Activity Modification: The first step is to identify a level of activity that will keep the patient active but not irritate the tendon further, usually a VAS pain score of 5/10 or less during activity that settles within 24hrs is a good place to start.
- Gradual Loading: As the tendon heals, gradual loading is recommended to strengthen the tendon and promote tissue remodeling. The key is to progressively increase the intensity and duration of activities, allowing the tendon to adapt without being overloaded. Using slow heavy resistance training is best practice for loading a tendon.
- Eccentric Exercises: These exercises involve lengthening the tendon under load and can be a useful tool to help patient use higher loads than they could otherwise tolerate with isotonic exercises, particularly in the Achilles and patellar tendons. Eccentric loading can significantly reduce pain.
2. Manual Therapy
- Massage and Soft Tissue Mobilization: Techniques such as deep tissue massage or myofascial release can help reduce muscle tightness around the affected tendon, improve circulation, and relieve pain.
3. Pain Management and Modalities
- Cryotherapy: Applying ice to the affected area can help reduce inflammation and control pain, especially during the initial stages of tendinopathy.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs can help manage pain and inflammation, though they should be used cautiously, as inflammation is not always the primary issue in tendinopathy, especially in degenerative cases.
4. Shockwave Therapy
- Extracorporeal Shock Wave Therapy (ESWT) is an evidence-based treatment option that uses high-energy shockwaves to stimulate healing in the tendon. It promotes blood flow and collagen synthesis and has shown promise in treating chronic tendinopathies like Achilles and calcific shoulder tendinopathy.
Conclusion
The cornerstone of conservative management for tendinopathy focuses on load management and strengthening exercise to promote healing and restore capacity of the tendon. Alongside these, manual therapy, pain management, and shockwave therapy may provide additional support in the recovery process. By gradually increasing tendon load and utilizing targeted therapies, most individuals can experience significant improvement without the need for invasive treatments.
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