Is it tendinopathy or tendinitis? And how do I fix it?

Tendinopathy is a term used to describe a condition involving the tendons, which are the thick cords that attach muscles to bones.

It encompasses a range of tendon disorders characterised by pain, swelling, and impaired function.

These characteristics reduce tolerance to exercise.

Tendinopathy can affect various tendons in the body, commonly seen in the Achilles tendon, rotator cuff, patellar tendon, and elbow tendons.

A term previously used was tendinitis, but more recent research has now shown that active inflammation is not always responsible for tendon pain, so we now use the term tendinopathy.

Physiotherapy plays a crucial role in the management of tendinopathy, focusing on reducing pain, improving function, and promoting tendon healing.

Key aspects of physiotherapy management for tendinopathy

Pain management

• Ice and heat therapy: Alternating between ice and heat applications can help manage pain. Ice is generally applied in the acute phase, while heat may be beneficial in the later stages to promote blood flow and relaxation.
• Medication: simple pain relievers such as paracetamol can be useful to control some tendon pain.

Exercise prescription

• Isometric exercises: Isometric exercises involve static muscle contractions without joint movement. These exercises can help in building strength without placing excessive stress on the tendon. These exercises can provide good pain relief and are sometimes more effective than stretching. They assist in loading the tendon allowing it to accommodate to normal pressure and function.
• Concentric exercises: Concentric exercises involve the contraction of the muscle tendon units, through a muscle shortening phase. It is important to develop concentric muscle strength as this allows the muscle to provide movement and function through normal activity.
• Eccentric Exercises: Eccentric exercises involve the lengthening of the muscle-tendon unit during contraction. They are often prescribed to improve tendon strength and resilience. These exercises can be used later in the rehabilitation process to prepare the tendon for higher loads.
• Gradual progression: Exercise programs should be tailored to the individual, gradually progressing in intensity and duration to avoid overloading the tendon. Tendon overload is a common mistake in exercise prescription and can lead to increased pain and loss of function. A balance between not enough load and overload is important to improve strength and tolerance in the tendon leading to healing.

Biomechanical assessment

• Gait analysis: For lower limb tendinopathies, assessing the individual’s gait and addressing any biomechanical abnormalities can be crucial.
• Posture correction: Improving posture and addressing any muscle imbalances can contribute to reducing stress on affected tendons.

Manual therapy

• Soft tissue massage: Massage techniques may be used to alleviate muscle tightness and improve blood circulation.
• Joint mobilisation: Gentle joint mobilisation techniques can be applied to improve joint mobility and reduce stiffness. A stiff joint will put increase pressure on tendons and therefore exacerbate the symptoms of tendinopathy.
• Education and activity modification:
• Educating the Patient: Providing information about the condition, its causes, and the importance of adherence to the prescribed exercises is essential.
• Activity modification: Advising on modifications to activities or sports that may exacerbate the condition can aid in the healing process.

Orthotics and bracing

• Orthotic devices: In some cases, orthotic devices may be recommended to correct foot mechanics and reduce strain on lower limb tendons.
• Bracing: Depending on the location and severity of tendinopathy, bracing may be used to provide support and limit excessive movement.

It’s important to note that the management of tendinopathy should be individualised, and consultation with a healthcare professional, such as a physiotherapist or sports medicine specialist, is crucial for an accurate diagnosis and tailored treatment plan.

Additionally, the principles of the management may vary based on the specific tendon affected and the stage of tendinopathy (acute or chronic).

Each type of tendinopathy may require specific physiotherapy interventions tailored to the characteristics and location of the affected tendon.

Here’s an overview of physiotherapy management for Achilles tendinopathy, patellar tendinopathy, and gluteal tendinopathy:

Achilles tendinopathy

Load management

• Gradual progression of weight-bearing exercises.
• Eccentric strengthening exercises for the calf muscles.
• Modification of activities that contribute to excessive stress on the Achilles tendon.

Stretching and mobility

• Gentle calf stretching exercises to improve flexibility.
• Ankle joint mobilisations to enhance range of motion.

Orthotics and footwear

• Assessment of footwear and provision of supportive shoes.
• Consideration of orthotic devices to correct any biomechanical issues.

Modalities

• Ice therapy to manage pain

Manual therapy

• Soft tissue massage to address muscle tightness.
• Joint mobilisations to improve ankle joint mobility.

Gait analysis

• Evaluation of walking and running biomechanics to identify and correct abnormalities.

Patellar tendinopathy

Quadriceps strengthening

• Eccentric exercises for the quadriceps muscles.
• Isometric exercises to build strength without excessive strain on the tendon.

Patellar taping

• Taping techniques to provide support and alleviate stress on the patellar tendon.

Stretching

• Gentle stretching of the quadriceps and hamstring muscles.
• Addressing any muscle imbalances contributing to patellar tendinopathy.

Biomechanical assessment

• Assessment of lower limb alignment and biomechanics.
• Correction of any abnormal movement patterns contributing to the condition.

Modalities

• Ice therapy for pain management.
• Electrical stimulation for pain relief.

Gluteal tendinopathy

Hip strengthening

• Focus on strengthening the gluteal muscles, especially the gluteus medius.
• Eccentric exercises to improve muscle control.

Core stability

• Incorporation of core stability exercises to enhance overall pelvic and hip stability.

Biomechanical correction

• Evaluation of gait and hip biomechanics.
• Addressing any pelvic tilt or hip joint issues contributing to tendinopathy.

Modalities

• Ice therapy to manage pain.

Soft tissue techniques

• Soft tissue massage to release tension in the gluteal muscles.
• Trigger point therapy if muscle knots are present.

Activity modification

• Advising on modifications to activities that aggravate the condition. This includes avoid crossing legs, lying on effected side and minimising excessive stair climbing in the early phases.

In all cases, a comprehensive assessment by a physiotherapist is crucial to determine the underlying factors contributing to tendinopathy.

The treatment plan should be tailored to the individual, considering factors such as the stage of tendinopathy, biomechanics, and specific functional goals.

Patients are usually actively involved in their rehabilitation, performing prescribed exercises regularly and adhering to lifestyle modifications to promote optimal healing.