Tendinopathy
A tendon is a strong and fibrous connective tissue that attaches a muscle to bone. When a muscle contracts, force is generated and transmitted through a tendon, to create joint movement.
Tendinopathy is an umbrella term that involves painful conditions and dysfunctions in the tendon.
Tendinopathy is broken down into two stages; tendonitis and tendinosis.
Tendinitis
Tendinitis refers to micro-tears in a tendon due to repetitive overload followed by inflammation.
It is important to note that this is not to be confused with tendon strains which are traumatic in nature.
Tendinosis
Tendinosis refers to degeneration of the tendon’s collagen due to excessive and prolonged overuse after the onset of tendinitis without giving the body enough time to heal. The full inflammatory process is an important for tendon healing and is absent in tendinosis.
Tendinitis vs. Tendinosis
1. Injury Onset
Tendinitis is acute in nature and occurs after exhibiting a combination of excessive force and/or repetitive stress.
Tendinosis is chronic in nature and begins with tendinitis. When tendonitis is left untreated, the normal process of healing malfunctions and the injury is then classified as tendonitis. It takes approximately 6 weeks for untreated tendonitis to evolve into tendinosis.
2. Treatment Goals
With tendinitis, the primary goals are focused on reducing further injury, overload, and inflammation.
With tendinosis, the primary goals are focused on reducing stress on the tendon, reduce unwanted cellular processes and vascularization to prevent further tendon thickening, and optimize strong and healthy tendon formation and maturation.
3. Management Stratagies
1. Manual Therapy
Deep-friction massage: to improve circulation, collagen regeneration processes, and optimize tissue alignment.
Myofascial release: to reduce pain, tightness, and inflammation of the muscles, joints, nerves, and fascia of the affected and compensatory areas.
Joint mobilization: to promote smooth joint movement and mobility of the ankle joint.
2. Biomechanical Optimization
Movement pattern conditioning: improving biomechanics for balanced muscle recruitment reduces demand on the injured tendon.
3. Load Management
Taking rest breaks is important in reducing the demand on the tendon. Regarding repetitive work tasks, taking a 5 to 10 minute break every hour is recommended.
4. Modalities
Ice: provides vasoconstriction to reduce abnormal vascularization of the tendon. Ice for 10-20 minutes a day and after engaging in aggravating activities.
Ultrasound: use of high-frequency sound waves to produce deep tissue heating to reduce muscle tension, fascial tension, and inflammation.
Laser therapy: to improve blood flow, reduce pain and inflammation, and promote tissue healing.
Acupuncture: use of thin needles to improve local and systemic function, regulate the nervous system, and promote the body’s natural healing processes.
Electrostimulation: use of electrical currents to stimulate muscles and reduce pain.
5. Nutrition
Vitamin C, manganese, zinc, Vitamin B6 and Vitamin E are important for collagen synthesis and tendon health.
6. External Support
Bracing and taping provides support for the tendon and reduces tensile load.
4. Recovery Time
The recovery time for tendinitis can range from days up to 6 weeks, with a better outcome if treatment is started earlier compared to later.
The recovery time for tendinosis if treated early can be 6-10 weeks; but in chronic cases can take up to 6-9 months.