What is tendon pain and how common is it?
Often termed ‘tendinitis’ or ‘tendinosis’, but has more recently been described as ‘tendinopathy’. Tendinopathy can be classified into acute or reactive tendinopathy and chronic or degenerative tendinopathy. The main job of a tendon is to store and release energy and act a bit like a spring. Tendons have to put up with a lot of impact and load. Think of the achilles tendon for example, which transmits forces from the muscles to the ankle when we walk, run, jump etc. When tendons can no longer keep up with the load that is being placed upon them, or maybe there was too much load too soon, tendon injuries occur. This is often described as a load-intolerance problem.
Some common tendon injuries we see in the clinic are achilles, gluteal and forearm (tennis elbow or golfer’s elbow). Tendon issues are common in the sporting population, but also for the general population.
Who gets tendon pain?
It is often assumed that just athletes/active people get tendon pain, however we use our tendons like a spring throughout our entire life, even with things like stepping off a curb or walking up stairs. Tendinopathy usually occurs as a result of a change in load (volume and or intensity of an activity) relative to the tendon. For example, going from zero running at all to running 2-3 times a week. This quick change in load can put the achilles and gluteal tendon at greater risk of injury. Tendon injuries occur across the lifespan and patients will present with varying levels of pain, irritability and capacity to function. There are also other factors that can influence tendon pathology such as age, genes, sex, biomechanics, body composition and inflammatory factors.
Warm up phenomenon (pain gets better as activity continues)
Worse after activity (especially the following day)
Load related pain
How can Physio help?
Your Physiotherapist will conduct a thorough assessment, to determine possible causes and contributing factors of your tendon pain. This assessment also includes the exclusion of anything sinister (otherwise known as Red Flags). While we know that a smaller proportion of people will present with pain that is sinister in nature, it is really important not to miss these presentations. Traumatic tendon injuries do occur, such as an achilles tendon rupture.
Provided there are no Red Flags or contraindications, your Physio will then work with you to establish some goals for your treatment and then create a treatment plan. This will include activity modification/load management to assist with pain reduction and to allow the tendon to adapt, exercise (specific to the tendon) to improve load capacity, strength (for surrounding muscles) and or mobility and manual therapy for symptom relief. Tendon rehab can be a little tricky sometimes, as tendons behave quite differently to muscles. There isn’t a ‘one recipe fits all’ - tendon rehab, like all rehab, needs to be individual, processive and load sensitive. Your Physiotherapist can work with you to identify the right exercises for you in order for you to recover and return to your regular activity and or sport.