What is Tendinopathy?
Tendinopathy is the broad term used to describe pain at or along the insertion of muscle into the bone. Tendons are what connect our muscles to the bone and often times we can strain or injure the tendons. When injury occurs to the tendon we call this a tendinitis with the suffix “itis” referring to inflammation in the tendon. Without proper care and healing this injury can turn into a more serious problem termed tendinopathy. When an injury to a tendon lasts longer than 4-6 weeks and starts drifting towards over 3 months this becomes a chronic issue and is harder to treat. This is where the research starts to lack sufficient evidence as to why pain and injury linger. It is theorized to result from mechanical overuse with inflammation during the acute stage and degeneration in the chronic stage1.
The problem with treating tendinopathy is that when researchers look at the quality of the tissue at the tendon injury, inflammatory cells are not always present. Often times the tendon may appear darkened or thickened. Our bodies attempt to heal the injury but instead of laying down parallel collagen fibers a matrix that is thicker and weaker with more water, more immature cartilage and less organization is seen under microscope2. Small blood vessels and nerve endings can often be seen in this new matrix of weakened fibers that may be part of the cause for continued pain throughout this process.
Here is an example of normal tendon on the left(A) and injured tendon on the right(B):
What are the symptoms?
Symptoms may include but are not limited to:
- Pain and stiffness in muscle/tendon which may be worse morning or night
- Muscle or tendon may be tender or present with swelling
- Weakness or stiffness associated with using the muscle/tendon
What do we know?
- The muscle and tendon have changes in the structure of their collagen
- Muscle and tendon are weakened from the structural changes
- Pain is present due to weakness, growth of nerve endings and central nervous system
What do we do?
- IASTM has shown promising evidence in helping to remodel the collagen fibers to their original parallel configuration and strength
- Eccentric exercise/ specific exercise can be used to help re-inforce the remodeling collagen
Pain can be controlled through various therapeutic modalities
- Modification of activity is sometimes necessary and should be guided by health care professional
1.Eckenrode B, Stackhouse S. Improved Pressure Pain thresholds and Function Following Noxious Electrical Stimulation on a Runner with Chronic Achilles Tendinopathy: A Case Report. Int J Sports Phys Ther. June 2015; 10(3): 354-362.
2. Xu, Yinghua; Murrell, George. The Basic Science of Tendinopathy. Clin Orthop Relat res. July 2008; 466 (7)