Winning the Battle Against Tendinopathy
Have you been diagnosed with tendinopathy, tendinosis or tendinitis? Are you still fighting lingering symptoms of pain and tightness months or even years later? Tendinopathy is a common condition for both athletes and the general population. Runners often develop Achilles Tendinitis, young athletes frequently get patellar tendinitis and rotator cuff tendinopathy is common in adults. In this blog, we will discuss new protocols for treating tendinopathy that relieve symptoms, get you back to your active lifestyle and help prevent reinjury!
Tendinopathy is any condition that affects a tendon, making it painful to use. Tendons are rope-like connective tissues that attach muscles to bones. Most people injure their tendons by overusing them, although other factors can contribute to weakening of your tendons. Tendinopathy can begin when a tendon injury can’t heal.
Tendinitis and tendinosis are two different types of tendinopathy. Tendinitis is inflammation in your tendon. This typically occurs after an injury; however, it can become chronic if the injury doesn’t heal. Tendinosis is a chronic condition involving degeneration of a tendon with breakdown of the collagen in your tendon, which makes it lose its strength and elasticity.
It's not always clear how tendinopathy develops, but it often starts with overusing your tendon. Athletes can strain their tendons by overtraining. People who aren’t regularly active can strain a tendon by suddenly increasing their activity; such as, a full day of yardwork in the spring.
Typical treatment for tendinitis has been rest, ice, stretching and then eccentric strengthening exercises. Eccentric training is slowly lengthening your muscle with weight to return to your starting position. For example, in a bicep curl, when you bend your elbow that is the concentric phase of the exercise. Then when you slowly control the straightening of your elbow back to your starting position, that is the eccentric phase of the movement. If you slowly squat, the descent into the squat position is an eccentric exercise.
Unfortunately, time has shown that 60% of patients performing eccentric exercises still have symptoms 5 years after the onset of Achilles tendinopathy. Does this mean eccentric exercise is bad or the wrong treatment? No! It just means that it is not simply the only answer and there is more to be incorporated into the treatment program.
Research conducted to address the issue of lingering symptoms pointed to the benefit of isometric and heavy load strengthening. Isometric means holding a muscle contraction without movement. For example, a plank and wall sit are isometric exercises. Treatment has shifted away from stretching tendinopathies to strength training, even shortly after the injury. We recommend slow movements with moderate to heavy resistance. Then, on the last repetition the patient should hold the isometric contraction.
We have combined this approach to therapeutic exercise with dry needling and myofascial release to achieve great results! Dry needling helps to stimulate repair in the tendon and muscle. Myofascial release breaks up scar tissue and facilitates tissue remodeling. We also always provide guidance on safe participation in sports, work and household chores while recovering from an injury.
Whether you are struggling with a chronic tendinopathy or a more acute injury a multifaceted approach of therapeutic exercise, dry needling, myofascial relief and education will help you return to an active lifestyle and prevent recurrence.
References:
Fung D, Wang V, Laudier D, et al. Subrupture tendon fatigue damage. J Orthop Res 2009;27:264-273
Rees J, Lichtwark G, WolmanR, et al. The mechanism for efficacy of eccentric loading an Achilles tendon injury: an in vivo study in humans. Rheumatol 2008;47:1493-1497
Merza E, Pearson S, Lichtwark G et al. The acute effects of higher versus lower load duration and intensity on morphological and mechanical proper<es of the healthy Achilles tendon: a randomized crossover trial. J Exper Biology. 2022;225(10)
Baar K. Training to improve musculoskeletal performance and accelerate return to play. Keynote lecture at the Sports Congress in Copenhagen, 2018
