At Total Physiotherapy we see a large number of patients who suffer with tendon overuse injuries. These injuries are typical of patients who have recently increased their workload, increased their training intensity (in sport), or started a new activity (gardening/DIY). There are a number of different theories for the cause of tendon pain and disrepair. It was believed that the reason for pain was due to inflammation of the tendon itself, known as tendonitis, with inflammation at a cellular level contributing to the pathological process. However a large amount of scientific research has shown that there were no inflammatory cells present in patients who underwent surgery for tendon pain.

The most recent research explains that the dysfunction is related to a non-inflammatory response of the tendon cells, known as tendonopathy. With an increase in load put through a tendon, in a repetitive nature, the cells within the tendon become activated and the tendon becomes thicker due to slight swelling and increased water content. As the tendon is repeatedly overloaded, without a modification in activity, the tendon structure begins to change with the cells and structure becoming disorganised. Blood vessels and nerves begin to grow within the tendon, increasing its thickness and affecting its structure/function. If the activity is not modified or the correct treatment is adhered to, this process will worsen, less collagen will be present in the tendon and the structure will become weaker, predisposing the tendon to tears or even rupture.

What activities cause tendonopathy? 

As mentioned above, tendonopathy is generally related to repetitive movements which are completed in an incorrect manner with poor biomechanics. It can be also indicative of an individual starting an activity at too high an intensity, putting the tendon under too much stress without allowing the tendon to repair itself. This may be that an individual has decided to take up running in order to lose weight and get healthier. However, due to poor gluteal and hip stability when running, excessive load is put through the Achilles tendon causing the tendon structure to change and become irritated. Without the adequate rest and treatment, the tendon will continue to be damaged and the pain will increase (Achilles tendonopathy), affecting the individuals running ability.

Another example may be that an individual has started gardening in the spring and developed shoulder and arm pain. The tendons in the arm and shoulder will be put under stress through the repetitive gripping and overhead movements. This will cause the tendon structure to be altered as mentioned above and cause pain in the forearm (tennis elbow or golfers elbow) or at the rotator cuff muscles in the shoulder (rotator cuff tendonopathy). 

Another example may include an individual who has just started at an exercise class at the gym, whether this is zumba fitness or circuit training which involves a lot of jumping movements. After a few sessions they may notice a pain over the front of their knee. This will be through excessive loading of the patella tendon with jumping and repetitive high load forces being applied through the knee, often referred to as patellar tendonopathy or ‘jumpers knee’.

How will the pain present itself?

Tendon injuries present relatively consistently between different patients. This includes pain some time after the exercise, more commonly the morning after. The individual may find the area is pain free when resting but then becomes painful during activity. During an activity the patient may find they can ‘run through’ the pain, with the pain disappearing after warming up, and returning during the cool down period.

How can physiotherapy help tendonopathy?

As mentioned above, at Total Physiotherapy we see a large number of patients who suffer from tendon related injuries and we have a very high success rate with treating and curing these injuries. Treatment for tendonopathy is a very hot topic and there are a number of different treatment options that have proven to be beneficial in experimental research. At Total Physiotherapy we use evidence based research to ensure that we provide the most up to date and effective treatment options when treating tendonopathy.

Firstly the physiotherapist will complete a thorough assessment in order to determine where the problem lies and why the injury is occurring. It may be due to muscle weakness, muscle imbalance, poor biomechanics, or simple due to overuse. In most cases it is a combination of all the above. It will then be the physiotherapist’s decision to how they will treat the injury, depending on the stage of the tendon injury. Most commonly soft tissue massage will be used initially however as mentioned before this will depend on the stage of the process.

The patient will then be shown specific exercises to improve their biomechanics and strengthen muscles to prevent muscle imbalances and overuse of certain tendons. Further treatment methods such as Acupuncture, Joint Mobilisation, Stretching, Trigger Points and Taping may be used.

The use of orthotics may also be used in order to correct a patient’s biomechanics and prevent over pronation and excessive stress put through the Achilles tendon and preventing plantarfasciitis (damage to the plantarfascia on the sole of the foot).


© Total Physiotherapy Limited 2019