What Is a Tendon?
A muscle is made up of a central part — the muscle belly — which contracts and produces movement at a joint, and its peripheral parts, which act like ropes and attach to a bone: these are the tendons. A tendon works both like a rope and like a stiff spring; it has a small amount of give in its length and can store energy. The tendon is composed of long collagen fibres wrapped in connective tissue — like small ropes — and together they form the larger structure, the tendon.
What Is Tendinopathy and What Are Its Symptoms?
Tendinopathy is the broad term that covers any disorder of the tendon, whether chronic or acute, with or without pain. Tendinopathy occurs when the limit of elasticity is exceeded, or when the continuity of some of the collagen fibres within the tendon is disrupted. The symptoms of tendinopathy are:
• A reduction in the strength of the muscle
• Atrophy of the muscle in chronic conditions
• It may be accompanied by pain, but in advanced stages this is not necessarily the case
Tendinopathy can be caused by:
• A sudden, abrupt, heavy load that the tendon is not accustomed to bearing
• A small load that is repeated continuously and overstrains it
• A shear load — a force perpendicular to the tendon — that causes injury, which may result either from a direct blow or from chronic overuse
What Are the Stages of Tendinopathy?
Tendinopathy has 3 stages:
• Reactive tendinopathy: This is the painful stage, the initial stage of the condition, accompanied by a thickening of the tendon at the site of injury.
• Tendon dysrepair: This is the intermediate stage, in which the collagen fibres regenerate but are not aligned with the tendon, which appears thickened. There is no pain, and with the appropriate treatment it is possible to return to the previous stage.
• Degenerative tendinopathy: This is the final stage, in which the collagen fibres can no longer be repaired and many have lost their continuity. A tendon rupture under a sudden heavy load is a serious risk. At this stage there is no pain.
Because the tendon is made up of bundles of collagen fibres that function like small tendons, they are not all affected at once; instead, some are healthy while others may be at one of the three stages of tendinopathy. In other words, a single tendon can be in all three stages at the same time.
What Do We Mean by Tendinitis?
The term tendinitis is older, although it is still widely used. It describes the painful stage of tendinopathy which, however, with current understanding, we now know may not involve inflammation — and this is why, in some cases, anti-inflammatory medication does not provide relief.
How Is Tendinopathy Treated?
Tendinopathy is treated with physiotherapy and with advice to the patient regarding changes to daily life or, in the case of athletes, to training. Treating the tendon requires:
• Offloading — resting the tendon. We provide advice on the adjustments needed in daily life or in training.
• Gradual reloading, with tailored and specialised exercises, both eccentric and concentric. The dosage of exercise is decisive, depending on the stage, for controlling pain.
• Muscle strengthening. Strengthening the muscle improves the torque it exerts on the joint and the resilience of the tendon, as well as its tolerance of shear forces.
It is very important to address the pain in tendinopathy so that the patient can progress to the next stages of treatment. To manage the pain, we apply:
The Orthopaedic Manual Therapy Physiotherapist Mr Konstantinos Danalis applies a specialised method of exercises combined with electrotherapy and massage, with immediate results in reducing pain.
What Will Happen If I Do Not Treat My Tendinopathy?
A tendinopathy that goes untreated becomes chronic. The symptoms usually recur over the years, and the resilience of the tendon and the strength of the muscle gradually decline. Over time, the risk of a tendon rupture increases significantly.
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Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009 Jun;43(6):409-16. doi: 10.1136/bjsm.2008.051193. Epub 2008 Sep 23. PMID: 18812414.
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