Tendon Injuries

What is a tendon injury?

A tendon is the connective tissue that attaches muscle to bone. Tendon injury (tendinopathy) is usually due to overuse of the tendon, resulting from increased or repetitive load. This leads to changes within the tendon structure, which make it harder for it to cope with the load.

Tendinopathy is seen as a continuum involving 3  main phases.

Reactive tendinopathy:
When a tendon is overloaded there is a short term adaptation in the tendon structure. This causes it to thicken to reduce stresses and allow the tendon to cope with load better.
If the overload is reduced and/or the tendon is given enough recovery time between loading, then it can return back to its normal tendon structure.

• Usually occurs with an increase in training load or sometimes after a direct blow to the tendon
• More common in the younger population

Tendon dysrepair:

If the tendon continues to be excessively overloaded, it continues its attempt at healing by further changing its structure. The collagen that makes up the tendon becomes disorganised and of a poor quality, which results in slower healing and decreased strength in the tendon.

Degenerative tendinopathy:

In this final stage of the continuum, the tendon has become degenerative. The collagen becomes very disorganised and cannot deal with load very well. If continued overloading occurs, there is an increased risk of rupture.

• Occurs due to chronic overloading
• Athlete with a history of repeated bouts of tendon pain
• More common in the older person

However, it is not always this clear cut. As tendinopathy is a continuum different parts of the tendon may be in a different phase. For example, a degenerative tendon could have areas of tendon that are in the reactive or disrepair phase.

Common types of tendinopathy

Tendinopathy can occur in any tendon of the body, however there are some tendons that are more commonly affected.

Lower limb

• Achilles tendinopathy
• Patella tendinopathy (“Jumper’s Knee”)
• Gluteal tendinopathy
• Hamstring tendinopathy
• Adductor tendinopathy

Upper limb

• Rotator cuff tendinopathy
• Lateral epicondylalgia (“Tennis elbow”)
• Medial epicondylalgia (“Golfer’s elbow”)

What are some of the general signs & symptoms of a tendinopathy?

• Pain with activity
• Eased by rest
• Morning stiffness
• Tender to touch the affected tendon
• History of recent increase in load (e.g. increased volume of training or work, started a new sport or activity)
• History of direct trauma to the tendon

What is the treatment for a tendinopathy?

The treatment and management of a tendinopathy will differ depending on what phase it is in. Our physiotherapists will be able to determine this by conducting a thorough assessment and decide upon an appropriate treatment and rehabilitation program for you. The most important thing in all stages is that the tendon is gradually loaded to allow it to adapt and improve its ability to cope with load.

For a tendon in the reactive phase, a period of modified load is necessary to allow the tendon time to adapt, become less reactive and return to a more normal structure. Although complete rest is not helpful, 2-3 weeks of modified activity is important. Your physio will also start you on strengthening exercise program. The type and amount of activity and exercise you do in this phase will be individualised to you based on your presentation and assessment findings.

In a degenerative tendon, there is less requirement for a period of modified load and management can be more immediately focused on strengthening exercises and a graduated loading of the tendon involved.

There are many factors that can contribute to a tendinopathy and it is important that these are addressed. For an athlete this can include looking at training loads (i.e. frequency, intensity, duration), footwear, equipment, flexibility, muscular strength and endurance, biomechanics and sport specific technique (e.g. running, jumping, swimming, throwing). In occupational related injuries, it may also be necessary to look at ergonomics, posture and specific techniques involved in work and home related activities.

Keep an eye on our website for past/future blogs with more specific information on each of the common types of tendinopathies.

Written by Rachael Dodds