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Facts of tendon injuries or tendinopathy to know

Tendinopathy refer to pathology/sick of a tendon which may include inflammation (also known as tendonitis) , degeneration (tendinosis).

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1) Tendinopathy does not improve with rest alone. The pain may diminish but will often returning at the same or worse level of pain. This is because rest does nothing to increase the tolerance of the tendon to load.

2)  Anti-inflammatory medication is not indicated for tendon injuries. There are some inflammatory cells involved in tendinopathy, but it is not considered to be a classic inflammatory response. Anti-inflammatory medication may help in situations of high pain levels but it is unclear what effect they have on the actual cells and the problem inside the tendon. 

3) There is a big variety of factors that may cause tendinopathy but the main factor is a sudden change in certain activities. –  These include 

  • Activities requiring the tendon to store energy (i.e. walking, running, jumping), 
  • Activities that loads and compress the tendon
  • Biomechanics (e.g. poor muscle capacity or endurance) 
  • Systemic factors (e.g. age, menopause, elevated cholesterol, increased susceptibility to pain, etc). Predisposed people may develop tendon pain with even subtle changes in their activity.

4) Exercise together with SHOCKWAVE therapy is the most evidence-based treatment for tendinopathy. Shockwave therapy assist in breaking down scar tissue and rebooting the healing process. Tendons need to be loaded progressively so that they can develop greater tolerance to the loads that an individual needs to endure in their day-to-day life. 

5) In the initial phase determining and modifying load is important in settling tendon pain. This often involves reducing abusive tendon load that involves energy storage and compression and adjusting and modifying activities can be of great effect.

6) Pathology on imaging such as MRI’s or Ultrasound imaging is NOT equal to pain as the general population will also present with common pathology and have no pain.  So if you have been told you have ‘severe pathology’ or even ‘tears’ this DOES NOT necessarily mean you will not get better or have a poorer outcome. 

7) Tendinopathy rarely improves long term with only passive treatments such as massage, therapeutic ultrasound, injections, shock-wave therapy etc. Exercise is often the vital ingredient and passive treatments are adjuncts.

8) Injections should be avoided as much as possible as this is often associated with a poorer outcome especially multiple injection

9) Exercise needs to be individualised as we all have unique biomechanics, training regimes and gaols. These are based on the individual’s pain and function presentation. There should be progressive increase in load to enable restoration of goal function whilst respecting pain and need to be monitored to make sure short-term gaols of rehabilitation phase is met.

10) THERE ARE NO SHORT CUTS……Tendinopathy responds very slowly to exercise. Patience is a virtue so ensure that exercise is correct and progressed appropriately. Resist common temptation to accept ‘short cuts’ like injections and surgery. There are often no short cuts.

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