Tendinopathy
If you’re one of the many people out there that is in the
midst of dealing with a tendon injury (aka tendinopathy),
then you may be wondering what exactly is going on with
this all-important tissue and why is it causing you such
grief.
Before we delve into this topic however, let’s start from
the start. What exactly is a tendon and what is it built to
do? In brief, a tendon is a tough connective tissue that is
made up of collagen and usually attaches muscle to
bone1. Its cellular make up gives it the ability to withstand
high loads whilst also allowing for some flexibility and elasticity1.
So given its all-star properties, what can lead to tendon injury you ask? Other than direct
trauma, gradual wear and tear as a result of overuse and/or aging is the usual culprit2,3.
When a particular motion is repeated over and over again (such as in exercise, sporting
activity, or in relation to a job), overload of the tendon can occur1. This can lead to
micro-damage, inflammation (early on in the picture) and eventually degeneration and
weakening1,4.
As a result of this injury process, you may experience pain, stiffness and eventual
weakness of the affected area. Pain initially occurs at the site of
a tendon during an exercise/activity or can decrease with
warming up1,5. With time and persistent activity, healing can be
impeded and more damage can ensue leading to pain with light
activities, and soreness and stiffness with rest and disuse1,5.
So what can be done about all this? Well, resting from the
aggravating activity so that recovery can occur, and trying as
best as you can not to overload the injured tendon is the first
point of call1. However, in the instance that that pesky tendon should still be causing
you grief, then you may need to consider other treatment modalities. These include but
are not limited to:
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Manual therapy, such as osteopathy. Treatment can help reduce your pain and
address any compensating factors that may have arisen as a result of the injury.
Osteopathy treatment will use a range of techniques including soft tissue
massage, muscle energy technique, and counterstrain to help alleviate your pain.
Advice about appropriate imaging (should it be required), stretching and
eccentric strengthening exercise can be given to help aid the rehabilitation
process.
Anti-inflammatory medication and cortisone injection. Such treatments have
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been shown to help reduce pain in the early stages of the condition, but have
limited success later on1. This is because researches studying the condition of
tendons at the later stages of injury have found minimal amounts of
inflammation or complete absence of it1,6.
Sclerosisng therapy. In this procedure a solution is injected into the affected
tissue targeting the new haphazard nerves and vessels that have arisen in the
tendon following injury1. Such nerves and vessels contribute to the pain process
and thus their elimination can be beneficial to the patient1.
Nitric oxide patches. These patches have been shown to decrease pain and
improve the strength of certain injured tendons1,6,7. This includes the
supraspinatus tendon of the shoulder, the tendon affected in tennis elbow, and
possibly the Achilles’ tendon1,7
Platelet rich plasma (PRP) injection. PRP has been shown to have important
healing actions in various tissues8. It has been used successfully in the treatment
of specific tendinopathies, as well as ligaments, certain muscle tissue and
musculoskeletal conditions8.
Ok, so now that you have all this interesting information just remember that when you
are considering any treatment modality to always consult your primary healthcare
practitioner in order to make an informed decision as to which option is most suitable
References
1. Abate, M et al, 2009, Pathogenesis of tendinopathies: inflammation or degeneration?, Arthritis
Research & Therapy 11:235
2. http://www.webmd.com/first-aid/tc/tendon-injury-tendinopathy-topic-overview
3. Tendon Injuries: Basic Science and Clinical Medicine. By Nicola Maffulli. 2005
4. Järvinen M1, et al., 1997, Histopathological findings in chronic tendon disorders.
Scand J Med Sci Sports. Apr;7(2):86-95.
5. Clinical Sports Medicine. By Peter Brukner and Karim Khan, Revised 3rd Edn. 2009.
6. Andres, B M, 2008, Treatment of Tendinopathy: What Works, What Does Not, and What is on the
Horizon, Clin Orthop Relat Res. Jul; 466(7): 1539–1554.
7. Murrell, G A C, 2007, Using nitric oxide to treat tendinopathy., Br J Sports Med., Apr; 41(4): 227–231.
8. Wellingto, K H etal., 2013, Platelet-rich Plasma in Orthopaedic Applications: Evidence-based
Recommendations for Treatment, J Am Acad Orthop Surg., vol. 21 no. 12 739-748
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