What is Tendinopathy? The Symptoms & Treatment Options

Tendinopathy conditions occur in people who perform repetitive activities, such as sports or specific occupations. An Australian study showed that between 21.5% and 25.2% of professional Australian Football League (AFL) players experience Achilles (ankle) and patellar (knee) tendon pain.[1] The Australian Journal of General Practice suggests that 1-3% of Australians experience outer elbow tendon pain (tennis elbow), particularly in workers who need to lift frequently.[2]

Although “tendonitis” and “tendinopathy” are used interchangeably, they have slight differences. Tendonitis describes inflammation of the tendon rather than degenerative changes seen in tendinopathy. Research has suggested that inflammation may have a minor role in tendon pain, which explains why “tendinopathy” is becoming a more common condition.[3]

Read on to understand what you should know about tendinopathy; the risk factors, treatment options and expected recovery time.

What is Tendinopathy?

Tendinopathy (similar to tendonitis) is a painful condition caused by the gradual degenerative changes of the tendon. Every muscle has at least one tendon which connects it to a bone(s). Tendinopathy can occur in numerous areas, including the Achilles, shoulder and elbow.

What are the symptoms of tendinopathy?

Tendinopathy is characterised by a combination of pain, stiffness, swelling, muscle weakness and potential inflammation. These symptoms are specific to the joint or area of the body where the tendinopathy is occurring.

Common symptoms of tendinopathy

• Difficulty in performing specific movements

• Weakness

• Easy fatigability of the muscles

• Pain

• Swelling

• Tenderness

What causes tendinopathy?

All variations of tendinopathy are characterised by overuse of the muscles in sport or general activities. This may be more chronic overuse, such as in runners training over a long time, or for anyone who has recently increased their training capacity too rapidly.

Common causes of tendinopathy

• Repeated high-intensity movements

• Not enough rest periods

• Poor posture

• Poor biomechanics

• Recurring injuries

Common conditions that present with tendinopathy

As tendinopathy progresses, it can lead to inflammation of the tendon resulting in a condition known as tendonitis. Here are the most common conditions that can present with tendinopathy:

• Tennis elbow - A painful condition that results from inflammation of tendons on the outer part of the elbow.

• Golfer’s elbow - Developed from an overuse injury of the tendons responsible for bending your wrist.

• Rotator cuff tendinopathy - An overuse injury of the shoulder muscles that is characterised by pain and discomfort during overhead movements.

• Achilles tendinopathy - Involves inflammation and degeneration of the Achilles tendon resulting in difficulty walking and running.

• Patellar tendinopathy - Tendinopathy of the patella tendon which sits below the kneecap.

• Biceps tendinopathy - Teninopathy of the biceps muscle in the upper arm.

• Peroneal tendinopathy - Tendinopathy of the peroneal tendon, which runs down the outside of the lower leg.

• Jumper’s knee - A painful condition that results from inflammation of the patellar tendon, which connects your kneecap to your shin.

Sports that increase the risk of tendinopathy

Sports that involve repeated high-intensity movements increases your risk of having tendinopathy.

• Baseball

• Swimming

• Soccer

• Tennis

• Long-distance running

How is tendinopathy diagnosed?

Having tendinopathy can be detrimental to your daily activities and affect your quality of life because of the pain during movements. Moreover, chronic tendinopathy can lead to tendon complete tendon rupture and other complications.

There are several options available when it comes to diagnosing your tendinopathy. One of the more common and most recommended by Australian GPs is an assessment from a physiotherapist.

Physiotherapists are rehabilitation experts that deal with muscle and tendon injuries. They can reliably diagnose various forms of tendinopathy and provide appropriate medical treatment.

A physiotherapy assessment is straightforward. Your physiotherapist will start the consultation with a mini-interview to take your medical history. Use this time to discuss all of your medical concerns with your physio.

After taking your medical history, your physiotherapist will perform different physical tests to assess your tendon and determine the root cause of your pain and discomfort.

Your physiotherapist will then formulate a diagnosis and a specific treatment plan for you that will guide you through your recovery.

This will also include:

• Detailed treatment plans

• Target recovery time and rehabilitation goals

• Home therapeutic exercise programs

• Professional advice.

How is tendinopathy treated?

Early symptoms of tendinopathy such as pain and discomfort may come and go. However, microtears and soft tissue damage can accumulate in your tendon, resulting in loss of function and difficulty performing movements over time.

There are several options when it comes to treating tendinopathy. One of the most common and the treatment option referred to by Australian GP’s the most is physiotherapy.

Physiotherapists frequently manage muscle and tendon injuries such as tendinopathy. They are in the best position to provide quality care and help you regain your normal function.

The primary goal of your treatment is to help you manage the pain, ensure proper healing of your tendon and reduce the risk of reinjury.

Depending on the severity of your tendinopathy, a physiotherapist may provide you with a combination of the following types of treatments:

• Cryotherapy - Cold modalities to reduce swelling and pain.

• Heat therapy - Heat modalities to improve blood circulation and decrease muscle spasms and pain.

• Dry needling - Specialised acupuncture techniques to help reduce pain and muscle spasms.

• Manual therapy - Hands-on techniques your physiotherapist uses to help improve joint range of motion and reduce pain.

• Taping - Specialised taping techniques provide additional stability on your joints and decrease the stress on your tendons.

• Stretching exercises - Stretching techniques to help relieve muscle tension and prevent stiffness.

• Therapeutic exercises - Exercise techniques to correct impairments and poor biomechanics that are contributing to your condition.

• Sports-specific exercises - Specialised exercise strategies to help you regain your function and return to your sports.

• Progressive resistance exercises - Gradually increasing resistance exercises to progressively challenge the tendons and make them stronger.

• Postural training - Exercises that will improve your posture to reduce the stress on your tendon, especially on the shoulder region.

Next step - Creating a treatment plan made for you

After your first visit, your physiotherapist will create a detailed treatment plan based on your assessment and goals to maximise your recovery.

Self-care for tendinopathy

If you think you have tendinopathy, here are the best things you can do and avoid.

Things to do:

1. Rest

Give your body enough time to heal by resting and drinking enough water throughout the day. Tendons do not receive enough blood circulation and take longer to heal.

2. Ice

Apply ice on sore tendons and muscles for 10 to 15 minutes every few hours to decrease inflammation.

3. Massage

Apply gentle pressure on your affected muscles to relax tensed muscles and relieve muscle stiffness.

4. Stretch

Gently stretch your muscles and tendons to help maintain the normal range of motion of your joints.

5. Exercise

Remember that complete rest is not advisable if your tendinopathy is chronic. You still have to remain active and do controlled strengthening exercises to strengthen and assist the tendon’s recovery.

Things to avoid:

1. Avoid high impact activities

High impact activities such as sports that involve jumping and long-distance running can contribute to the breakdown of joint cartilages.

2. Avoid pushing through the pain

Pain and discomfort are signals from your body to tell you that something needs your attention. This may suggest that you need to rest your muscles and tendon to prevent further injury.

3. Avoid smoking

Smoking can cause a reduction in blood supply that needs to reach your tendons. Tendons require vital nutrients carried by your blood in order to heal.

Do I need a specialist or surgery?

Your GP may order diagnostic tests and imaging to confirm their diagnosis and rule out other factors that may be causing your symptoms.

• Ultrasound - This can be used to assess the integrity of your tendon.

• X-ray - Can be used to check for the presence of bone malformation and scan arthritic changes on the bone that can contribute to your pain.

• MRI - Can show the degree of damage or degeneration around the affected tendon.

Your GP may prescribe you corticosteroid injections for short term pain relief and management of inflammation.

In severe cases, tendinopathy can lead to complete rupture of your tendon and may require surgery to reconstruct the tendon.

Your doctor can coordinate with a physiotherapist to provide you with appropriate intervention. Successful treatment of tendinopathy strongly relies on proper rehabilitation and therapy.

What is the recovery time / prognosis for tendinopathy?

Recovery time is dependent on your proactiveness to seek professional treatment and the severity of your injury.

Tendons have a poor blood supply and may take up to 6 months to fully recover from tendinopathy, while mild cases can improve within 6 weeks of rehabilitation.

A physiotherapist can help you manage the recovery process, providing guidance on exercise, treatment and appropriate rest times.

Important factors in recovery include:

• Sticking to your rehabilitation program and regularly exercising

• Resuming your sports activity gradually

• Paying attention to pain, and resting as necessary.

Can tendinopathy be prevented?

Tendinopathy is an injury which can be prevented. The key things are to ensure adequate rest between training and exercise and maintain good strength and flexibility. If you are already suffering from tendinopathy, these tips will also reduce the likelihood of the injury re-occurring later.

• Stretch regularly – Regular stretching can help maintain your natural range of motion and reduce tension in your muscles and tendons.

• Gradually increase your activity– Abrupt changes in your physical activity and exercise intensity can damage your tendons. By gradually increasing the intensity of your exercises, you will be able to give time for your tendon to adjust to your new routine.

• Strengthen your muscles and tendons – Strong muscles and tendons are more resilient to stress and can overcome greater loads.

• Pace your activities – Avoid excessive stress on your tendons and allow proper recovery periods.

Outlook and the main takeaways

Tendinopathy can be frustrating and take a long time to heal due to poor blood circulation around the tendons. It is vital to catch early signs of tendinopathy and pace your activities.

Activity modification and proper strengthening program is the key to treating tendinopathy. Book a consultation with a physiotherapist and start your journey to start your recovery today.

Anatomy of the tendon

Tendons are rope-like structures that connect your muscles to the bones. As the muscles contract, it pulls on the tendon, pulling the bones and joints toward the same direction.

Tendons act as a resilient spring that can store energy for high-impact activities such as running and jumping. However, excessive stress on your tendons results in microtears that can accumulate over time.

The tendon’s degeneration rate can overcome your healing response resulting in recurring pain and chronic injury.