Tendinopathies – What, why & how?

The what…

Tendinpathies are a common problem experienced by everyone from the elite football player to the weekend warrior. It is predominately experienced in the Achilles tendon, the patella tendon and the hamstring tendon. Other places these can occur are the biceps tendon, the tibialis posterior tendon and the peroneal tendon.

Commonly, tendinopathies will present by being sore first thing in the morning and/or start of the aggravating activity – and easing as the down goes on or the activity commences. It is frequently characterized by a combination of pain, swelling and inability to perform an activity to its full potential due to the condition.

The why…

A combination of internal and external factors creates tendinopathies.

Internal factors: Such as someone’s biomechanics, the way they jump, land, kick and run are all contributors.

External factors such as spikes in training intensity or loads, change in pitch conditions, or a change in footwear can set off the tendon.

The how…

To put it simply – the tendon can not react to the load or ‘stress’ it is being put under quick enough. “Too much, too soon” is the phrase often inserted here.

The tendon quickly goes into a state that is ‘reactive’ in nature and now works as a dysfunctional tendon – causing pain with activities that did not previously cause pain.

So where to from here?

Strong research recently here in Australia has pointed to static holds as the answer early on with an acute (reactive) tendinopathy. These holds allow from load to be put through the tendon without the tendon having any ballistic/explosive forces put through it that are gained with jumping and landing where the tendon needs to work its hardest. 3-4 sets of 20-45 seconds, a couple of times a day are required early on this phase of rehabilitation.

Once this early stage has settled, an introduction to higher loads, and jumping/landing can be added. Eccentric exercises can also be used now to load the tendons.

Fun Fact…

Complete rest is a big no, no! Tendons enjoy some load being put through them, rather than complete rest. Given that a spike in load will come after a period of complete rest – this now starts to make a lot more sense if you remember the reason why tendinopathies can come about from above. So no need to give up running, playing sport, riding – whatever it may be completely, but modify the activity as appropriate. Physiotherapy plays a big role in the education and guidance of a proper tendinopathy rehab, so don’t be afraid to ask for advice!

Written by

Pete Colagiuri
Sports Physiotherapist

Pete has over 20 years experience as a Physiotherapist and specialises in running biomechanics and complex injuries. He believes that you must identify and fix the underlying cause of an injury, to recover faster, prevent recurrences and improve performance.

Pete Colagiuri - Sports Physio