Tendon injuries are among the most common types of musculoskeletal conditions. This condition is often labeled “tendonitis”, but advances in scientific research have led to a revised perspective on the underlying cause of tendon pain. Although acute tendon injury can lead to inflammation, by far most tendon problems are degenerative in nature. In other words, the substance of the tendon has broken down over time due to chronic, excessive loading. This has led to the more accurate designation of “tendinopathy”. Tendons most susceptible to tendinopathy include the rotator cuff tendons, the lateral aspect of the elbow (“tennis elbow”), and the Achilles tendon.
Tendinopathy may begin as an inflamed tendon following exposure to excessive loading. At this stage, modification of activity and treatment of the inflammation may resolve the problem. In many cases, however, the external stress on the tendon is not altered enough, and the acute injury leads to a more chronic problem involving tissue breakdown. Then a vicious cycle ensues, whereby the now weakened tendon is less capable of withstanding stress, which leads to further degeneration. And what started as intermittent tendon pain during activity has now progressed to more constant pain even at rest. It is often at these later stages, when the condition is more serious, that people seek care.
Understanding the nature of the problem is important in directing proper treatment. Medical treatment, at least in the past, has been centered around the use of anti-inflammatory medication. These medications, however, are not effective beyond the acute phase of the injury. Management of these types of injuries should start with an assessment of the stage and severity of injury, as well as evaluation for musculoskeletal impairments (muscle strength, joint range of motion).
Physical therapists are ideally poised to evaluate and treat tendinopathy. Physical therapists perform comprehensive physical assessments, and consider the condition in the context of the individual’s movement health as a whole. They can determine how best to modify loading on the involved tissues in order to optimize healing and restore function. They utilize interventions that can help control pain, and will prescribe exercises to begin building the strength of the compromised tendon and muscle unit. They can also prescribe exercise to maintain function of the surrounding joints or musculoskeletal structures. Finally, they can provide guidance on return to normal activity or sports participation.
It is ideal to address tendon injury in the early stages in order to prevent a progression of the problem. If you do have a tendon condition that is not getting better, see your physical therapist.
Marcia Miller Spoto PT, DC, OCS