internal structure on tendon

Tendinopathy or Tendonitis ?

What is Tendon ?

The muscle consists of a central, contracting part, which moves a joint and hte peripheral parts that act as "rope" and attach to a bone , the tendons. The tendon acts as a rope and as a sping at the same time, having a small change at it's length that allows energy storage. The tendons constist of long collagen fibers, wraped in connective tissue, that all toghether create the tendon.

What is Tendinopathy and what are the Symptoms ?

Tendinopathy is a medical term that includes all forms of tendon pathology, acute or chronic, with or without symptoms. Tendinopathy is caused when the elastic barrier of collagen fiber within the tendon is breached, and their continuum is severed. The sumptoms of tendinopathy are :

  • Muscle weakness
  • Muscle atrophy in chronic conditions
  • Pain might be present, but that is not valid for the advanced stages of the clinical condition

Tendinopathy Risk Factors

Tendinopathy risk factors are :

  • Sudden, unexpected load, beyond the capability of the tendon
  • Small constantly recurring load, causing stain to the tendon
  • Shear load causing injury, either by direct hit, or chronic wear off

Which are the stages of Tendinopathy ?

Tendinopathy has 3 stages :

  • Reactive Tendinopathy - This is the painful, initial stage of the clinical condition, that is accompanied by swelling at the trauma spot.
  • Tendon dysrepair - This the the intremediate stage, where collagen fiber production is proliferated, but fibers are not aligned to the axon of the tendon. Swelling is also present at this stage. Pain is not present at this stage and restoration the the previous stage is possible.
  • Degenerative Tendinopathy - This is the final stage, where collagen fibers are discontinued. At this stage rupture of the tendon is imminent by a -not so large - load. No pain is present at this stage.

Because the tendon consists of many collagen fibers, wraped toghether like many smalle tendons, not all are severed at the same time, but some might be healthy, and others in a stage of tendinopathy, so in a tendon all 3 stages can be present at the same time.

What is Tendonitis ?

The term Tendonitis is older, although stilled used. It is about the painful stage of Tendinopathy, at which according to currect medical knowledge, inflammation might not be present. That is why in many cases anti-inflamatory drugs are ineffective.

How is Tendinopathy Treated ?

Tendinopathy is treated with Physical Therapy. Patient consulataion is primary, since changes in everyday life, or training are needed. Treatment include :

  • Load decrease - resting of the tendon. Counseing on the changes needed in everyday life, or teining for athletes
  • Gradual load increase, adopted and specialised exercise to patient needs, including eccentric and cocentric exercises. Exercise dosage is crucial and stage-depedent for controling the pain.
  • Strenghtening - that increases the size of the muscle and the torque tha muscle applies, as well as the tendon endurance and exposure to shear forces, providing long term health.

It is important to treat pain, initally, so that the patient can proceed to the next stages of treatment. Methods for tendon pain treat are:

Orthopedic Physical Therapist Konstantinos Danalis applies specialized methods of exercise and electrotherapy and amssage with immediate pain relief.

What If I do not Treat Tendinopathy ?

An initial stage tendinopathy that is not treated may become chronic and deteriorate to advanced stage. Symptoms keep reccuring periodically, as the tendon gradually degenerates. Eventualy it loses strength and endurance and is prone to rupture even with small loads.

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