Tendinopathies can be a real pain!
They generally have a long and slow recovery, but we have some top tips we wanted to share with you surrounding this condition.
Exercise is the most evidence-based treatment for tendinopathy.
Tendinopathy research strongly advocates for exercise to be the first line of treatment. Tendons need to be loaded progressively to develop greater tolerance to the loads placed on it. Most often, a tendinopathy will not improve without load.
Tendinopathy is not considered an inflammatory condition.
Although there are some inflammatory changes going on, it cannot be classed as a classic inflammatory condition. As a result, anti-inflammatories may help with extreme pain however it is unclear what effect they have on pathology and the actual cells of the tendon.
Tendinopathy does not respond well to rest.
Completely resting the injury will only cause the tendon to weaken and its load tolerance to decrease. Instead, modifying load is the way to go. This involves reducing (not completely stopping) the load in the short term and then slowly progressing the load in a safe and cautious manner.
Results seen on imaging does not equal to pain.
Remember, pathology is commonly present even in people with no pain whatsoever. Severe pathologies or even tears on a scan does not necessarily mean that you will have poorer outcomes. We also know that even treatments (exercise, injections) do not actually reverse the pathology (at least in most cases). Treatment instead focuses on improving pain and function rather than tissue healing.
Exercise programs need to be individualised.
A general approach does not work, the exercise program needs to be individualised to the patient and must be based on their pain and physical function. The aim is to slowly increase the load while also acknowledging pain levels in order to restore the goal physical capacity.
Passive treatment doesn’t work long term.
Techniques such as massage, therapeutic ultrasound, shockwave therapy and injections rarely improves tendinopathy in the long term. Exercise should be the central element of rehabilitation with passive treatments used as adjuncts.
Be patient… These injuries respond slowly
Just remember, tendinopathy responds slowly to exercise. You must perform the exercises correctly, be consistent and progress appropriately. Most importantly, you must have patience. Resist the temptation of taking shortcuts (e.g. injections, surgery). There are no shortcuts. Only consistency, time and effort.
It is important to get your injury assessed as soon as possible, as tendon injuries are much easier to manage when we get to them at an earlier stage.
Do you need help with a tendon. injury?
Make sure you call us on (02) 4800 1622 to book your appointment now.
Written by Nicholas Dimos (Physiotherapist)