Tendinopathy refers to an overload-related disorder that involves tendons –strong, thick bands of connective tissue that attach muscles to bone. Common tendinopathies include the Achilles, patella, lateral elbow, and supraspinatus (shoulder).
Previously, such problems were thought to relate to an inflammatory response within the tissue as the cause of pain, hence the name tendinitis. More recent evidence actually demonstrates that mechano-sensitivity and cellular breakdown of tissue actually drives the pain. This is an important piece of information that ultimately underpins successful, sustainable rehabilitation of tendon problems.
Unfortunately, many previous treatment options including cortisone injections, shockwave, various taping methods and surgery have been shown to have limited benefit in managing painful tendons.
Exercise-based rehabilitation has been proven time and time again to get the best long term results for tendinopathy. Most studies around exercise have focused primarily on the patella (knee) and Achilles tendon due to their generally high prevalence, however all tendinopathies are responsive to strengthening in its various forms.
Thorough, individual assessment is extremely important in order to prescribe the right type and amount of exercise at the right time. Unfortunately, there are no short cuts when trying to rehabilitate a painful tendon and setting it up for long term resilience. Loading programs will often take several weeks to months and require due diligence on the patient’s behalf – not something that many physiotherapists will admit, hence why people with tendon pain are often unsuccessful in their rehabilitation!
Andrew Robertson, Physiotherapist, Evoker.