Tendons connect a muscle to a bone, and can be found from the tip of your toes, all the way to the base of your skull. They are sometimes described as linear, ‘organised’ tissues, that absorb force, and active as a link between the muscle creating the force that moves a bone or joint. When injured, these tendons can tear or become ‘disorganised’, which decreases their ability to do their job effectively. You can either have an injury where the tendon attaches to the bone, known as an insertional tendinopathy, or within the main tendon itself, known as a mid portion tendinopathy.

What causes a tendinopathy?

One significant event, or a combination of gradual factors can cause a tendinopathy. These include:

• Age related changes to tendon, commonly seen in the hip and ankle

• A sudden increase in activity, or change in activity, commonly seen in ankle, knee, and elbow

• Specific sports or activities can predispose you to different tendinopathy types. For example, jumping sports such as basketball have higher numbers of tendinopathies in the knee, while endurance running can cause Achilles tendinopathies

• A recent increase in weight, decrease in muscle (such as feeling sick or having surgery), or a combination of both can result in your tendons not being able to handle your activities

What symptoms would we expect?

• Potentially swelling around the tendon, particularly after exercise, or even what feels like a lump inside the tendon

• A stiffness around the whole area, made worse by activity

• Aching around the area, that can last for hours, or even days after activity

How do we diagnose these issues?

In the early stages of an injury, prompt assessment, activity modification, and rehab can be implemented if we suspect a tendinopathy. Particularly in age-related changes, imaging and invasive interventions often isn’t required. In some acute injuries where a tear or significant damage is suspected, imaging such as an ultrasound scan or an MRI may be warranted to confirm the extent of the injury, which may require subsequent onward referral to an Orthopaedic surgeon.

“My scan says I have a tendon issue”

We know that how certain body paerts appear on a scan often doesn’t correlate with pain. For example, as we age, most people will have ‘degenerative’ tendons on a scan, but many people are asymptomatic ie. have no symptoms, and perform their activities pain-free. Scan results should be used alongside your symptoms to decide what, if any treatment you should have. Conversely to this, someone may have a very painful tendon, which looks completely ‘normal’ on a scan.

Self-management of a tendinopathy

Pain relief is very important in the early stages of a tendon injury. This may be regular icing, over the counter painkillers, or a prescription medication. The use of medication is often only advised after speaking with your GP or other health professional. The next step is to modify your activity. Complete rest is rarely the best treatment for a tendon issue, and often reducing your activity by 50% and reassessing the situation is the best option for the first few days. If reducing your activity still has no beneficial effects, it would be advisable to speak to a health professional.

How can physiotherapy help your tendon?

After an initial assessment, your physiotherapist will suggest whether this issue is appropriate for rehabilitation-based management, or whether it requires onward referral. A physiotherapist with a well-structured strength and conditioning programme can guide you back to your activities, without having to take huge breaks caused by flaring your tendon by doing too much. Rehabilitation with a physiotherapist takes the guesswork out of your training, and spares you the wasted time of doing too much, then doing too little, and will help expedite the recovery process.

If you are currently experiencing tendon problems and you would like a a plan to get back to all of your activities pain-free, then book an assessment with one of our physios.