What is tendinopathy?

Tendinopathy refers to a condition that affects the tendons, which are the strong, fibrous cords that attach muscles to bones. It’s characterised by pain, swelling and impaired movement in the affected area. While the term tendinopathy is often used interchangeably with tendinitis (inflammation of the tendon), it more broadly encompasses both acute and chronic tendon issues, including tendinosis, which involves tendon degeneration without significant inflammation.

What causes tendinopathy?

Tendinopathy is primarily caused by overuse or repetitive strain on a tendon. It often develops when a particular activity or movement is repeated frequently without sufficient rest, leading to small tears in the tendon tissue. Contributing factors include:

• Excessive or repetitive activity: Activities involving repetitive motions, such as running, jumping, or lifting, can increase the risk.
• Sudden increase in activity level: A rapid change in intensity, duration, or frequency of exercise or activity can strain tendons.
• Poor biomechanics or technique: Misaligned posture or improper movement can place undue stress on tendons.
• Age and degeneration: Tendons lose elasticity as people age, making them more prone to injury.
• Underlying conditions: Conditions such as rheumatoid arthritis or metabolic disorders can weaken tendons.

What are the symptoms of tendinopathy?

Tendinopathy typically presents with the following symptoms:

• Pain: Localised pain near the joint, often described as a dull ache that worsens with movement or activity.
• Stiffness: Particularly in the morning time, or inactivity over a prolonged period.
• Swelling: The affected tendon may appear swollen or feel tender when touched.
• Weakness: Reduced strength in the associated muscle group can be noticed.
• Crackling sensation: Some may feel a grating or crackling sensation when the tendon is moved.

The severity of these symptoms can vary depending on the extent of the damage and how long it has been present.

How is tendinopathy diagnosed?

A diagnosis typically starts with a physical examination and a detailed discussion of symptoms and medical history. A doctor may check for tenderness, swelling and range of motion in the affected area. To confirm the diagnosis or assess the severity of the condition, imaging studies may be recommended:

• Ultrasound: Useful for visualising tendon structure and detecting any tears or swelling.
• MRI (Magnetic Resonance Imaging): Offers a more detailed image of the tendon and surrounding tissue, especially useful in chronic cases.

What are the treatment options for tendinopathy?

Treating tendinopathy focuses on reducing pain, promoting healing, and restoring tendon function. Treatment options include:

Conservative management:

• Rest and activity modification: Reducing or modifying activities that trigger pain is often the first step.
• Physical therapy: Strengthening and stretching exercises tailored to the specific tendon can improve flexibility and function.
• Ice therapy: In order to reduce pain and inflammation, applying ice packs to the affected area can provide relief.
• Pain relief medications: Non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to manage discomfort.

Advanced treatments:

• Corticosteroid injections: May provide short-term pain relief but should be used cautiously as they can weaken tendons with repeated use.
• Platelet-rich plasma (PRP) therapy:  Injection of the patient’s concentrated platelets, which promotes healing.
• Shockwave therapy: Uses sound waves to stimulate blood flow and healing in the tendon.
• Surgery: Rarely required but may be necessary for severe cases where the tendon is damaged or ruptured.

Can tendinopathy be prevented?

Preventing tendinopathy involves adopting habits that reduce strain on tendons. Strategies include:

• Gradual increase in activity: Slowly building up the intensity and frequency of exercise allows tendons to adapt.
• Proper warm-up and stretching: Preparing muscles and tendons for activity can help prevent injury.
• Good technique and posture: Ensuring proper form during activities and exercises minimises undue stress on tendons.
• Strengthening exercises: Regularly incorporating exercises that target tendon and muscle strength can improve tendon resilience.

Tendinopathy, though often painful and limiting, can be effectively managed with the right approach. Early recognition and treatment are key to preventing chronic issues and promoting recovery. Consulting with a healthcare professional for a tailored treatment plan and advice on lifestyle modifications can help maintain healthy tendon function and prevent recurrence.