Tendons are notoriously tricky to manage but the earlier you identify a problem and develop some strategies to treat it, the faster your recovery. Tendons are those structures in your body that anchor your muscles to your bones. Their structure is complex but basically comprises of collagen fibres, tendon cells called tenocytes and a matrix to glue it all together.
Lower limb tendon problems are common in those participating in sports such as running, jumping, basketball and weight lifting to name a few. Patella and achilles tendons are the most likely to be affected but other less common examples are hamstrings, gluteus medius or iliopsoas (hip flexor) tendons. The rotator cuff tendons of the shoulder are frequent offenders in the upper limb.
Research into tendon pain and rehabilitation has been extensive over the past 5-10 years with Australian physiotherapists leading the way. We now no longer think of tendon pain as being an inflammatory process. Instead, tendon pathology can be categorised into three stages: Reactive, Dysrepair and Degenerative.
Reactive Tendinopathy is described as the tendons’ response to a rapid increase in load or direct impact. This stage is best managed with relative rest (eg. add a heel raise for an achilles tendon), isometric exercise (activating the muscle without movement), activity modification and avoidance of stretching or tendon compression. The tendon structure remains intact and this is usually a reversible process. Often the reactive phase is quite short lasting less than two weeks. Anti-inflammatory medication can be useful in this phase despite the lack of inflammation.
Dysrepair Tendinopathy is where the tendon structure begins to break down in response to continued overload. Eccentric exercises are often introduced here with caution (exercising the muscle/tendon complex as it lengthens) and gradually progressed to the point where sports levels can be increased. It is important in this phase to avoid compressing the tendon For example running up a hill puts a much greater compressive load on the hamstring tendon compared with flat running.
Degenerative Tendinopathy is more common in older athletes and is readily diagnosed via imaging such as MRI or ultrasound. In this stage, the tendon structure becomes disorganised, nodular and thickened. Persistent excessive loading can predispose it to rupture. First line management includes eccentric and isometric exercises along with activity modification. Improvements can take months and persistence and patience are the key. In some cases, conservative treatment fails and surgery or PRP injections (blood plasma injections) may be considered.
Unfortunately there is no recipe of exercises for tendinopathy. Programs will vary greatly between individuals and your health care professional is best placed to oversee your rehab strategies and return to sport.
Accurate assessment, diagnosis, education and management is the key along with a good dose of patience and motivation.
Reference: Cook J and Purdam C Br J Sports Med. 2009 Jun;43(6):409-16