Tendon pain is a common complaint amongst athletes and active people alike. Tendon pain is usually felt directly over the site of the tendon or where the tendon inserts into the bone. It is often worse with initial movement, then as you warm up it may start to feel better, but by the end of your session it may be worse again. Tendon pain is often worse with dynamic movements such as running and jumping.
Tendons are tensile structures in our body that attach muscles to bone. Their role is to transfer the force generated by muscles to act on the bone and create movement. Just like our muscles, tendons respond to load. If you go to the gym and do strength training your muscles will get bigger and if you load tendon they will become stronger and more resilient to high level forces.
What Causes Tendiopathy?
When we load tendons too quickly, in the wrong way or with excessive compressive forces, they can’t adapt in time and will malform into a pathological tendon structure. There is an increase in water content, disturbance of collagen (tendon cells) type and structure as well as ingrowth of nerve and blood vessels in the tendon. All of this contributes to pain and weakness felt in the tendon.
Tendinopathy runs on a continuum ranging from a mechanically weak tendon to a healthy, strong, resilient tendon to reactive tendinopathy to tendon dysrepair and finally a degenerative tendon. Depending on the loads applied to the tendon, it will move back and forth on this continuum as pictured.
Why rest doesn’t work
As you can see from the picture, complete rest results in a weak tendon rather that just return to a normal tendon state and therefore is not recommended. Continued inappropriate and excessive loading will further stress the tendon towards the degenerative stages. Appropriate and optimised tendon loading is important to restore normal tendon structure and create a healthy resilient tendon.
Should I take anti inflammatories?
Cellular studies of pathological tendon have shown no trace of inflammation, so despite the old term for tendon pain “tendonitis”, we know that inflammation is not causing the pain. So anti-inflammatories and rest won't help!
How to Treat Tendiopathy
The acute pain caused by a pathological tendon can initially be settled down with relative rest from aggravating activities, isometric exercises and a gradual loading program. However it is also important to identify the underlying cause of the tendinopathy so that it may be addressed. Otherwise the tendinopathy may not resolve completely or it may return in the future.
Common contributing factors include:
Weakness or underutilization in some muscles
Poor movement patterns or running technique
Training errors and poor load management
Poor joint mobility
When to see a physio?
If you have been experiencing pain as described above for >1 week, you should seek treatment. The sooner you seek treatment, the less damage you will do and the sooner you will get better! Your physiotherapist will assist you to reduce the acute pain as well as identifying the relevant contributing factors to your pain and address them with strengthening exercises, running drills/technique prompts, functional exercises and a load management plan. At Melbourne Sports Physiotherapy we will have you back doing your sport or hobby as soon as possible.
If you have sustained an injury from playing tennis or are just keen on a targeted, individualised injury prevention program book in with one of our Physiotherapists today!
Melbourne Sports Physiotherapy
Melbourne Sports Physio has a range of qualified and experienced professionals who can help provide ongoing support and treatment. Our friendly team are located in across Melbourne in Essendon, North Melbourne and Blackburn South, and appointments can be made by calling or booking online.