Tendinopathy is a common condition that affects millions of people worldwide, causing pain, discomfort, and sometimes limitations in movement. Tendinopathy is so common in specific activities we have developed colloquial terminology. Tennis Elbow is synonymous with lateral epicondylalgia, and is tendinopathy of the wrist extensor common tendon. Golfer’s Elbow is synonymous with medial epicondylalgia, and is tendinopathy of the wrist flexor common tendon. Jumper’s Knee is common in basketball, volleyball and even running, and refers to tendinopathy of the patella tendon. But tendinopathy can occur in any tendon, some other common areas include the achilles, the rotator cuff muscles, or the hamstring. In this blog post, we'll delve into what tendinopathy is, its causes, symptoms, cellular physiology, and how physical therapy can play a crucial role in its management and rehabilitation.
What is Tendinopathy?
Tendinopathy refers to a condition characterized by pain, swelling, and dysfunction of a tendon. Tendons are tough bands of fibrous tissue that connect muscles to bones, enabling movement and stability in the joints. When tendons are subjected to repetitive strain, overuse, or sudden injury, they can become damaged, leading to tendinopathy.
Causes of Tendinopathy:
Tendinopathy can develop due to various factors, including:
Overuse or repetitive stress: Activities that involve repetitive movements, such as running, jumping, swinging a tennis racket or lifting weights, can push a musculotendinous complex past its capacity over time, leading to irritation of the tendon, disorganization of the cellular matrix and eventual injury.
Poor biomechanics: Incorrect movement patterns or imbalances in muscle strength and flexibility can place excessive stress on certain tendons, increasing the risk of tendinopathy.
Age-related changes: Tendons naturally undergo degenerative changes as we age, making them less elastic and therefore prone to injury and slower to heal.
Poor training techniques: Inadequate warm-up, improper equipment, or sudden increases in intensity/speed or duration of physical activity can contribute to tendon injuries.
Cellular Physiology of Tendinopathy:
Tendinopathy involves complex changes at the cellular level within the tendon tissue. When a tendon is stressed past it’s capacity due to either rate of loading or volume the following processes will occur:
Matrix Degeneration: Tendinopathy is associated with alterations in the composition and organization of the tendon's extracellular matrix (ECM). This includes disruptions in collagen structure, increased production of matrix-degrading enzymes, such as matrix metalloproteinases (MMPs), and decreased synthesis of collagen and other structural proteins.
Inflammation: Chronic inflammation is a hallmark feature of tendinopathy. It involves the infiltration of inflammatory cells, release of pro-inflammatory cytokines, and activation of inflammatory pathways within the tendon tissue. This inflammatory response contributes to pain, swelling, and further tissue damage.
Neovascularization: Tendinopathy is often characterized by the formation of new blood vessels (neovascularization) within the tendon tissue. These abnormal blood vessels can compromise the structural integrity of the tendon and contribute to pain and dysfunction.
Nerve Ingrowth: In advanced stages of tendinopathy, there may be ingrowth of nerve fibers into the tendon tissue (neoinnervation). These sensory nerves can amplify pain signals and contribute to the persistent pain experienced by individuals with tendinopathy.
Physical Therapy for Tendinopathy:
Physical therapy plays a crucial role in the management and rehabilitation of tendinopathy. A physical therapist can create a personalized treatment plan tailored to the individual needs of the patient, which may include:
Pain management: Utilizing modalities such as dry needling with electrical stimulation to, joint mobilizations to alter neuromuscular signaling, and guided low level isometrics to reduce pain and inflammation.
Exercise prescription: Designing a customized exercise program focused on stepwise tendon loading progressions to encourage healing and remodeling of the damaged collagen network within the tendon.
Activity modification: Educating the patient on proper movement, activity and sport considerations as needed based on tendon healing timeline and symptoms to know when to return to activities and how hard to push it.
Conclusion:
Tendinopathy is a multifaceted condition involving structural, inflammatory, and neurovascular changes within the tendon tissue. It is essential to understand not only the clinical manifestations but also the underlying cellular physiology of tendinopathy. By integrating this knowledge into your treatment approach, we can develop effective strategies to manage pain, promote healing, and restore function in individuals with tendinopathy.
If you have any questions or need assistance in managing your own tendinopathy please schedule an appointment with one of our experts at Rise!