Tendinopathy: Early Recognition Key
Whether you are just getting into running or a seasonal veteran, you may have heard of ‘tendinopathy’ (formerly better known as tendonitis), and with the Gold Coast Marathon just around the corner we are seeing our fair share of them at the Ferry Rd Physio Southport Clinic, be that at the Achilles, patella, gluteal or hamstring tendons. Previously known as tendinitis, which translates to inflammation of the tendon (-itis=inflammation), we now know that tendinopathies are primarily not an inflammatory condition, rather a condition that involves cellular changes to the tendon and the arrangement of collagen fibres and its supporting framework, known as the matrix. This means that the traditional RICER (Rest, Ice, Compression, Elevation, Referral) acronym does not always apply, and treatment may in fact revolve more around correcting and modifying training loads.
How do I know if I have a tendinopathy?
Classic features include:
• Gradual onset of morning stiffness, which may resolve after 5-10mins (often worse on mornings after a run or activity the day prior).
• Stiffness felt after periods of inactivity.
- Pain/stiffness that tends to warm-up during the first 5-10 minutes of a run, but aches/stiffens again following activity.
- History of significant/radical changes in training load/volume, returning to training after a period of inactivity, or a change in training surface/footwear.
As always, a thorough assessment by your physio will help to confirm your diagnosis and the predisposing factors, or drivers, of your tendinopathy.
How do I treat it?
Optimal treatment results from an accurate diagnosis, and there are several other structures that could be causing your pain (such as the area around the tendon-paratendon, the retrocalcaneal bursa and nerves). Again, thorough assessment from your physio will help formulate an accurate diagnosis and therefore the most appropriate and effective treatment.
Tendinopathy is broadly broken up into three stages that form a continuum, and treatment differs depending on which stage you are in. Irrespective of what stage you are in, the evidence points towards load management as being the most vital part of treatment.
At Ferry Rd Physio, our treatment is individualised and specific depending on how clients present on any given day, which makes it difficult to give general advice. That being said, here are some handy tips to help avoid ‘running into trouble’ with your training.
- Progressively build up loads:
Tendons like a gentle ‘ramp’. Listen to your body, particularly the day or two after a run (this is the time period that tells us whether your tendons are tolerating the load or not) - Avoid compression of the tendon:
Although still being investigated, recent literature suggests that tendons like tensile (stretch) loads and dislike compressive loads, therefore avoiding positions that compress the tendon on underlying bones is important. Compression can also come from shoes or braces. - Begin some tendon specific strength training:
Controlled tensile loads stimulate the tendon cells to grow, multiply and strengthen. This strength training should then progress to functional, power, and sport specific training.
If your tendinopathy is sore, recent research has advocated the use of isometric (meaning the muscle is contracting but not moving the joint) exercises for analgesia (pain relief). Arguably the leading tendon researchers, Jill Cook and Craig Purdam, recommend the use of moderate to heavy load (Pain less than ~2/10) isometric holds for 40-60seconds, 4-5 times per day as an exercise to help decrease the pain associated with tendinopathy (Cook & Purdam, 2013).
Be prepared to be patient with tendinopathies, they do take time (up to 3-6 months), and while there are other options out there such as injections and surgery, there isn’t convincing evidence that these have better outcomes.
Load management, as well as specific manual therapy, exercise prescription, taping, education and biomechanical analysis from your physio will have you running on the right track.
If you have any specific questions feel free to contact us through email (info@ferryrdphysio.com.au) or if you would like to book an appointment regarding your tendinopathy or any other injury you can call the clinic on (07) 5532 0999, on enquire on our contact page.
Kevin W
Physiotherapist
Ferry Rd Physio and Functional Therapies
Southport, Gold Coast.
Cook and Purdam (2009) Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy.
Cook and Purdam (2013) The challenge of managing tendinopathy in competing athletes
Malliaras et al. (2013) Achilles and Patellar Tendinopathy Loading Programs: A systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness