Tendinopathy and Treatment
Not all tendon pain is the same and depending on what stage someone is at, their progress in rehab can be catered to their individual needs. For instance, someone who has very recent tendon pain, is treated differently than someone who’s had tendon pain for over three months. It is very important to have a thorough examination done in order to determine the root cause of the issue as well as a proper diagnosis.
Type of Tendon Injuries
Tendons can have different types of injuries and pathologies. For instance, there can be a reactive tendon, which is usually within the acute phase and that normally is within the first few weeks of onset.
A reactive tendon is called reactive due to the cellular response going on within the tendon.
Reactive tendons can also be one in which there is a direct blow to the tendon. An example would be if someone hit the Achilles tendon on a bike pedal. Reactive tendons are injuries brought on by a sudden increase in load beyond what the tendon can tolerate.
Degenerative tendons are those where that reactive phase has gone on for a longer duration of time. This is usually the type of pathology that goes on when a tendon injury is longer than 3 months time. The cellular response that occurs in the reactive continues which causes disruption to the tendon matrix, making it degenerative in nature. On a cellular level there are actual physical changes to the cells in the tendon. They become flattened and this makes pockets of degeneration within the tendon. The good news is that there are still healthy tendon cells around those areas of degeneration, which can be loaded and help maintain the health of the tendon.
The other type of tendon injury is not in the actual tendon, but located in the structure around the tendon. This is the tendon sheath called the paratenon.. This is differentiated by pain that’s brought on by movements that would cause a lot of friction but not loading. An example of this would be cycling for a prolonged period of time. That is because the flicking movement of the ankle can cause friction gliding at the paratenon to the tendon causing pain and swelling. It is very important to know the difference because if treated the same way as a tendon, that can actually increase the severity of one’s symptoms. Paratenon is treated quite differently from tendinopathy.
Paratenon Irritation and pain is not brought on by load, it is brought on by friction. If someone went out for a run with a tendon injury, normally that pain warms up and starts to feel better during and then tends to feel worse after. With a paratendon injury pain can happen with Running from the friction movement of the ankle. It would get worse as a run progresses.
Treating a tendon sheath injury is complete rest and offloading. That would also include a chunky heel or wedge heel lifts in order to mitigate how much friction happens. With a tendon injuries and we don’t really want to completely unloaded we want to
progressively load it in a manner that the tenant can tolerate.The only time complete rest is needed is when there is a complete tendon rupture.
Typically things to note about a tendonapathy is that it can handle heavy and slow loads. It cannot handle what will provoke pain and make it worse which is fast movement and explosive movements, which requires energy storage and release. Those type of movements would be if someone really goes through calf raises completely fast.. With that being said, energy storage and release movements will have to be rehabilitated later on in the phase of treatment in order for someone to return back to the activities that require those type of movements.
Isometrics are great to start with for pain relief and improving the strength in the muscle and tendon. Isometrics of movements where there is no change in range of motion. It is a sustained contraction.The duration of time that is recommended is 45 seconds to 1 minute followed by five repetitions with anywhere from 1 to 2 minute rest between.
Isometrics can be tolerated daily. Then within time one gradually goes through full range of movement. Those type of movements we call concentric and eccentric movement.
Things that can help tendon pain include anti-inflammatories, exercise, load modifications, orthotics let’s and supportive footwear. Things like extracorporal shockwave is also great to help as a modality however it does not take the place of a progressive treatment program.
Load management can be modified so that a person can still maybe do the exercise hey like doing, but finding a happy medium of what the tendon can tolerate. So that may be a run walk program or walking shorter walks splitting up walks of two shorter durations in a day or taking rests during the walks.
I hope you have found this helpful. A kind reminder that you do not have to struggle and I would be more than happy to help you conquer your tendon injury.