11 Feb Tendinopathy – What really happens….
Tendinopathies are extremely common in the athletic population, especially in those who jump, run and change directions. Initially it was thought that tendinopathies occur as an inflammation to the tendon and therefore cause pain. Tendinopathy is defined as a pathological process of the tendon.
Over the last couple of years new research has shown that the response that the body has when loaded is its way to protect itself and make it stronger.
When the tendon is put under more load then it is used to, it responds by depositing more collagen cells within the tendon. This then attracts greater amounts of ground substance. The proteoglycan called an aggrecan is deposited within the tendon and attracts large amounts of fluid which is why the tendon sometimes looks like it is swollen and inflamed.
This change in the tendon causes an increase in the ‘nociception‘ or pain sensation sent to the central nervous system.
This is why steroid injections rarely work in tendinopathies due to the lack of inflammation that is present.
When the relative overload of the tendon occurs there is a breakdown of the normal tissue. In the early stages the tendinopathy is considered reactive in where the changes to the tendon are not permanent and can be reversed. In the later stages with degenerative tendon there is a portion of degenerative tendon and a portion of ‘normal’ tendon. The normal tendon diameter is generally equal to or greater than when the tendon is not pathological. Therefore when rehabilitating the tendon there is still a large amount of normal tendon to strengthen – but the progressive loading is important to make sure that the tendon can deal with the load placed upon it.
If you’ve been diagnosed with a tendinopathy it means its not all bad news! You can be treated and there is still a lot that can be done. It can take a while to get back to the exercise or load that you would like, but the hard work is worth it. Definitely try the conservative treatment before grabbing for the seemingly easier quick fixes as they are not always the best option.
Remember stay agile, nimble and active!
Bachelor Exercise Science
Graduate Certificate Musculoskeletal Physiotherapy
Level 1 Triathlon Coach