Essential Tendinopathy Management

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Effective tendinopathy management will consist of an individualised management plan that encompasses progressive exercise, load management and education.

What is tendinopathy? 

• Tendinopathy most commonly means abnormal tendon tissue and pain
• The pain is usually worse during or after activity
• Some people have ‘stiffness’ in the morning or after rest

Why do we have tendons?

• Tendons transfer forces from the muscle to the bone to allow us to move
• Long ropey tendons like the Achilles often become painful because they absorb forces 

What causes tendinopathy? 

Many factors may contribute. Some we cannot change, such as: 

• Age: tendons become less able to repair themselves with age so the risk of injury increases.   
• Genetic predisposition: certain genes can increase the risk of tendinopathy. You may be more susceptible if other people in your family are also affected. 
• Your body alignment: how your bones are aligned may be a risk factor for tendinopathy. The good news is usually these factors only increase the risk slightly. 

There are some factors we can change to reduce the risk of tendinopathy:

• Activity: Doing too much walking, running, jumping, or repetitive arm use is a risk factor. These activities produce high tendons loads at fast speeds. 
• Obesity: excess weight increase load on your leg tendons, but also obesity may increase risk via biochemical mechanisms.
• Elevated cholesterol: high cholesterol is a risk factor for tendinopathy. Aerobic exercise, diet and medication may help you overcome tendinopathy.  
• Hormones: women are more susceptible around menopause. This is probably due to reduced estrogen levels at this time. 
• Muscle weakness: weak muscles are unable to protect the tendon and this can increase loads on the tendon and the risk of tendinopathy. 
• Biomechanics: the way that you move as well as your joint flexibility may place increase loads on your tendons and increase injury risk.

Should I be concerned about pathology?

• Pathology is not clearly related to pain
• Pathology is common in people without pain
• Even with very severe pathology your pain can improve
• Painful and pathological tendons hardly ever tear suddenly 

How do we treat tendinopathy?

First Line (All)

• Progressive exercise
• Load management
• Education 

First + Second Line (Some)

• Pain relief medication
• Aids such as orthotic therapy and taping 
• Passive treatments such as Shockwave Therapy 

First + Second + Thirdline  (Few)

• Injections 
• Surgery

Advice about physical activity

Initially you may need to reduce activities such as running and walking that are very painful until you have improved your load tolerance. Then you can GRADUALLY resume these activities. Monitoring your activity with a fitbit or exercise diary can be helpful to make sure you are not progressing too quickly.

Self-help strategies

If you have a mini-flare you can try the following:

• Reduce your activity for 2-3 days to allow pain to settle
• Ice or heat
• Anti-inflammatory medications if the pain is strong
• Self-massage or foam rolling

What else may help pain

• General physical activity or cross training like swimming or cycling
• Managing stress with mindfulness, meditation, relaxation, breathing techniques or yoga
• Managing sleep with strategies such as reading and limiting screen time prior to bed, medications like melatonin

Credit: Dr Peter Malliaras