Tendinopathy

September 11th 2015 |

What is it?

The word Tendinopathy basically means pathology of a tendon. It is an umbrella term for anything wrong with a tendon. The name Tendinopathy is preferred these days to Tendinitis or Tendinosis.

Tendons join muscles onto bones. When a muscle shortens and lengthens, it causes bones to move. That places strain on the adjoining tendon. Tendons are mainly compiled with lots of Collagen fibres that can withstand tensile forces really well. That makes them able to adapt to the force applied through the muscle. Tendons are usually designed to withstand this stress in one particular direction.

One theory suggests that Tendinopathy happens in three different stages.

Stage 1:

The tendon is sending pain signals to the brain in response to a force it is not used to. This as a warning signal for something that is going to become damaged. The muscles that join onto the tendon are too tight and are causing undue strain on the tendon. Think of this stage like an elastic band that is being pulled on too hard.

Stage 2:

New Collagen fibres are laid down by the body to try and strengthen the tendon. The tendon is still being subjected to the same force that caused a stage one Tendinopathy.

Stage 3:

Further Collagen fibres are laid down and the body tries to clear up what is effectively scar tissue by growing nerves and blood vessels into the tendon. This process is called neovascularisation. There is a lot more structural damage to the tendon in stage three which makes it much harder to fix.

Possible symptoms

Many different tendons in the body can be affected. The most common tendons affected include: Achilles Tendon; Patella Tendon (on the front of the knee); Common wrist extensor tendon (Tennis Elbow); Plantarfascia (under the sole of the foot) and Lateral hip Tendons (deeper Gluteal muscles or Piriformis).

In the early stages pain will be the main symptom. In later stages, pain will be accompanied by stiffness and sometimes a small tender lump over the affected tendon. The lump is when Collagen fibres and neovessels are present.

Tendons often feel better during exercise then stiffer afterwards. They are often stiffer in the mornings (because the tendon has not moved as much overnight).

Tendinopathy is most common in people over 30. However, the process may have started much sooner than that.

What can cause this?

There are different theories on why Tendinopathy develops. The traditional theory was that a tendon was subjected to a force is not designed to withstand. For example an Achilles Tendon likes to work in straight lines. If you overpronate (ankle rolls in too much when you walk or run), then the tendon bows or bends towards the midline of the body. That places strain on the inner (medial) side of the tendon. The change in loading pattern to the tendon causes small tears to develop in part of the tendon. The body sees this as a weak spot and lays down more Collagen fibres to stop it from getting any worse.

A more recent theory suggests that the tendon is simply subject to degradation throughout time in life. The tendons just wears out a bit over time. Imagine an elastic band that has been lying in a sunny window sill for a long time. It starts to look older and weaker.

If you think that you might have a Tendinopathy or want some advice on why it has happened and how to fix it, then call us on 01595 692727 or email on admin@injuryshetland.co.uk

Ross Smith
Physiotherapist