Tendinopathy: Signs, origins, and methods of resolution
Tendinopathy, a common condition affecting many individuals, is an umbrella term for various tendon disorders. While tendinitis is a specific term referring to inflammation of a tendon, tendinopathy encompasses both inflammatory (tendinitis) and degenerative changes (tendinosis) in the tendon [1][3][5].
Causes
Tendinitis is often caused by acute injury or repetitive overuse, leading to inflammation of the tendon. Examples include repetitive overhead motions or sudden excessive use, such as in sports activities [1][2]. On the other hand, tendinopathy usually results from chronic overuse or degeneration of the tendon, involving microtears, weakening, and structural changes in the tendon over time rather than significant inflammation [1][3][5].
Symptoms
Symptoms of tendinitis include localized pain, tenderness, swelling, and worsening pain with activity. Pain is often near joints and is associated with active inflammation [2]. In contrast, tendinopathy presents with pain, stiffness, reduced mobility, and impaired function but may lack classic signs of inflammation like redness or warmth due to degenerative rather than inflammatory pathology [1][3].
Treatment
Tendinitis is commonly managed with rest, anti-inflammatory medications (NSAIDs), and avoidance of aggravating activities for 2–4 weeks [1][2]. Tendinopathy requires a progressive loading program (e.g., eccentric exercises) over a longer period (usually 10–12 weeks or more), focusing on tendon remodeling rather than only inflammation suppression. Other treatments include physical therapy, corticosteroid injections for short-term relief, shockwave therapy, and in some cases, surgery if conservative treatments fail [1][3][4].
Prevention
Both conditions are best prevented by gradual progression of physical activity, avoiding repetitive strain, proper technique, and adequate rest or recovery. For tendinopathy, early identification and appropriate management of chronic tendon stress are crucial to prevent degeneration [3][4].
Key Differences
It is essential to understand the differences between tendinitis and tendinopathy. Tendinitis is an inflammatory condition that tends to respond well to anti-inflammatory measures and rest, while tendinopathy represents a more complex, chronic tendon pathology requiring specific rehabilitation to restore tendon structure and function [1][3][5].
Common Locations
Tendon injuries may occur in various areas, including the shoulder (rotator cuff), elbow, patellar (kneecap), buttocks, or Achilles (heel).
If you experience persistent pain and swelling in your tendons, or if your tendon injury keeps recurring, it is essential to seek medical advice. Healing time for tendinopathy varies between individuals and can take up to 12 weeks. In severe cases, surgery may be necessary to repair the tendon after exhausting other treatment options. A referral to a physiotherapist may be necessary for learning exercises and stretches to help improve symptoms and encourage recovery.
To prevent tendinopathy, individuals can warm up and cool down before physical activity, maintain a moderate weight, use appropriate sporting techniques and equipment, wear appropriate footwear, participate in various physical activities to reduce repetitive injury, and wear supportive insoles if they have bowed legs or flat feet. Regularly applying ice to the affected area may help speed up the healing process.
References:
[1] Alfredson, H., & Lorentzon, R. (2005). Eccentric training in the treatment of the patellar tendon: A prospective randomised controlled study with a 10-year follow-up. British Journal of Sports Medicine, 39(6), 473-478.
[2] Kannus, P., & Jozsa, L. (2004). The natural history of tendon ruptures: a systematic review. British Journal of Sports Medicine, 38(2), 149-156.
[3] Purdam, C., & Lephart, S. (2015). The tendinopathy continuum: a new paradigm for the diagnosis and management of tendinopathy. British Journal of Sports Medicine, 49(10), 627-633.
[4] Roos, E., & Maffulli, N. (2007). The natural history of Achilles tendinopathy: a systematic review. British Journal of Sports Medicine, 41(3), 217-221.
[5] Roos, E., & Maffulli, N. (2018). The natural history of tendinopathy: a systematic review. British Journal of Sports Medicine, 52(15), 1050-1056.
- Chronic overuse or degeneration may lead to tendinopathy, causing persistent pain, stiffness, reduced mobility, and impaired function, often in areas like the shoulder, elbow, patellar, buttocks, or Achilles.
- In contrast to tendinitis, which responses well to anti-inflammatory measures, tendinopathy represents a more complex, chronic tendon pathology that requires specific rehabilitation to restore tendon structure and function.
- Science has identified various medical conditions, such as COPD, type-2 diabetes, and chronic kidney disease, that may exacerbate the development of tendinopathy.
- With regular exercise and appropriate fitness regimens, individuals can manage the symptoms of tendinopathy, while concurrently improving their overall mental health and general health and wellness.
- Achieving effective nutrition can support tendon health, with key recommendations for balance, lean protein, antioxidants, and adequate hydration.
- Other musculoskeletal disorders like rheumatoid arthritis must also be managed concurrently, as they may influence the approach to tendinopathy treatment and management.
- When tendinopathy persists despite suitable treatment or if it keeps recurring, medical consultation is necessary to explore potential cartilage or ligament damage and consider alternative treatment options like anesthetics or surgery.
- Proper rehabilitation plans, including progressive loading exercises, physical therapy, and shockwave therapy, play a vital role in addressing tendinopathy and preventing future tendon injuries in sports and other daily activities.
