A Guide to Tendinopathy: Risk Factors, Treatment Guidelines and 10 Things to Avoid

Welcome. You’ve found your way to our informative guide on tendinopathy – or tendonitis, as it is more commonly known. This widespread condition affects a diverse population – from energetic athletes to more sedate seniors, and all others in between. This article will serve as a repository of useful knowledge on tendinopathy, presenting information on risk factors, sites of the body often affected, and providing fundamental guidelines to aid your recovery. We will also discuss 10 vital errors to avoid during the treatment of tendinopathy to accelerate your healing process. Let’s delve into the intriguing subject of tendinopathy and explore strategies for effective recuperation.

Risk Factors Contributing to Tendinopathy: 

Knowledge of the risk factors that can lead to tendinopathy is a fundamental step in understanding this condition. Several elements can predispose an individual to tendinopathy, such as:

  • Age: Tendinopathy occurrence increases with age as tendon health inevitably declines due to aging processes.
  • Overuse or repetitive movements: Engaging in activities or sports that repetitively strain the tendons can elevate the risk of tendinopathy.
  • Improper Technique or Form: Incorrect movement patterns or poor training techniques can exacerbate strain on tendons.
  • Inadequate Rest and Recovery: Tendons require ample time to heal, and not providing sufficient time for recovery can interfere with the healing process.
  • Poor Conditioning and Muscle Imbalances: Weak or imbalanced muscles, or inadequate physical conditioning can disrupt load distribution on tendons, rendering them more susceptible to injury.

Common Sites of Tendinopathy

Tendinopathy can affect a range of tendons in the body. Some areas often affected include:

  • Achilles Tendon: Located at the back of the ankle, this tendon is frequently susceptible to tendinopathy.
  • Patellar Tendon: Situated at the front of the knee, this tendon can be impacted by tendinopathy, particularly in activities involving repetitive running or jumping.
  • Rotator Cuff Tendons: These tendons in the shoulder are prone to tendinopathy.
  • Tennis Elbow (Lateral Epicondylitis): The tendons responsible for wrist extension on the outer side of the elbow often experience tendinopathy, especially in individuals performing repetitive gripping or wrist movements.
  • Golfer’s Elbow (Medial Epicondylitis): The tendons on the inner side of the elbow, responsible for wrist flexion, can also be affected by tendinopathy, particularly in individuals performing repetitive wrist or gripping actions.

Stages of Tendinopathy: 

Tendinopathy develops through 3 distinct stages, each bearing its own characteristics and treatment considerations:

Stage 1:

Reactivity – In this preliminary stage, the tendon cells are overloaded, leading to pain. Anti-inflammatory medications and a strengthening regimen focusing on heavy isometric loads are typically used as treatment.

Stage 2:

Disrepair – At this stage, the tendon structure becomes compromised, and sensitivity and pain may increase when loading the tendon. Proper management and appropriate loading strategies are integral for alleviating symptoms and promoting healing.

Stage 3:

Degeneration – This phase is characterized by soreness in the tendon during the morning, which improves as the day progresses. Imaging may reveal disruptions in collagen and the formation of blood vessels within the tendon. Strengthening exercises are crucial during this stage to encourage recovery.

*Note: These stages describe what is occurring structurally at the tendon and pain can be present or absent at any of these stages

Rehabilitation Planning:

A key aspect of a successful tendinopathy treatment involves working with a rehabilitation professional such as a physiotherapist. Here’s what you should focus on:

  • Customized Strength Program: A physiotherapist will design a tailored strength program that addresses your unique needs and aims.
  • Progress Gradually: Start with exercises that are manageable and slowly escalate intensity to promote healing without overloading the tendons.
  • Strength Focus: Concentrate on building overall strength and specifically on endurance if participating in endurance-based activities.

Avoid These 10 Common Mistakes During Tendinopathy Treatment:

When managing tendinopathy, there are several treatment avenues available. However, some are more beneficial than others. Here are 10 things to steer clear of during tendinopathy treatment, as highlighted in a British Journal of Sports Medicine article:

1. Complete Rest:

Rest decreases tendons’ load tolerance. Treatment should focus on reducing painful, high-tendon load and introducing beneficial loads when pain is low and stable.

2. Incorrect Exercise:

Slow exercises with moderate to high loads can be introduced early in rehabilitation. Avoid spring-like actions (i.e. running, jumping) of the tendon initially.

3. Reliance on Passive Treatments:

Passive treatments do not increase the load tolerance of the tendon in the long term. Electrotherapy and ice only provide temporary pain relief.

4. Injection Therapies:

These therapies have not demonstrated effectiveness in clinical trials. They should be considered only if the tendon does not respond to an exercise-based program.

5. Ignoring Tendon Pain:

An increase in pain should prompt a reduction in the training components overloading the tendon.

6. Stretching the Tendon:

Stretching can add compressive or tensile loads that are detrimental to tendon healing.

7. Friction Massage:

Massaging or frictioning the tendon can increase pain and does not assist with tendon pathology.

8. Using Tendon Images for Diagnosis, Prognosis, or as an Outcome Measure:

Abnormal tendon images in isolation do not confirm a diagnosis of tendon pain. Imaging is unlikely to change with treatment and reduction in pain.

9. Worrying About Rupture:

Pain is protective as it causes unloading of the tendon. Most people who suffer a ruptured tendon have never experienced tendon pain and do not present clinically.

10. Rushing Through Rehabilitation:

Tendons need time to build strength and capacity. Correct rehabilitation takes time, but long-term outcomes are positive when approached correctly.

Grasping the risk factors associated with tendinopathy, understanding the distinct stages of its progression, and avoiding detrimental practices will empower you to take proactive steps to reduce the likelihood of developing tendinopathy and enhance your rehabilitation journey. Our physiotherapists at Connect Physiotherapy & Exercise can devise an appropriate tendinopathy treatment plan and provide personalized care and support. Collaborate with our experienced physiotherapists to receive customized treatment plans, professional guidance, and a comprehensive assessment on your journey to recovery. Contact Connect Physiotherapy & Exercise today to schedule a consultation.

Note: It’s always crucial to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan.

Cook, J.L. Ten treatments to avoid in patients with lower limb tendon pain. British Journal of Sports Medicine 2018;52:882.

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Ruben San Martin

Ruben, MScPT, CSCS, NCCP Level 1 Olympic Weightlifting, is a physiotherapist uniquely blending research expertise in applied anatomy with a certified strength and conditioning coach background. Specialized in manual therapy, back disorders, exercise, and osteoarthritis, he is also a certified Olympic weightlifting coach. Prioritizing exercise therapy and hands-on manual techniques, Ruben emphasizes client education for active engagement and informed recovery. His writing aims to help clients return to an active lifestyle, optimize performance, and prevent injuries.