All about Tendinopathies

What is tendinopathy?

Tendons attach the muscles to the joint bones, transmitting muscle force to the bones during movement. The term tendinopathy refers to pathological processes of the tendons, which may occur with or without inflammation.

Tendinopathy can have several causes. Tendon injuries are estimated to account for 30–50% of all sports injuries. For example, Achilles tendon injuries are more prevalent in sports involving running, while shoulder problems appear in sports that involve throwing objects or overhead movements.

A frequent cause of tendon injury is excessive muscle development. The tendon, being strong but not very elastic, can suffer with repeated muscular exercise, responding to overexertion with inflammation. Excessive and poorly executed training can also cause tendon overload. In general, excessive demand together with repetitive micro-trauma are common causes of tendon pathology.

Tendinopathy also affects people who perform repetitive tasks in their jobs, sports or other routine activities. Household chores often require repetitive movements, and over time there is a risk of developing a tendinopathy.

Symptoms

Symptoms vary from patient to patient. The most common are pain and tenderness around the affected tendon. These symptoms may be accompanied by swelling near the injured tendon.

Patients frequently experience:

• Increased pain and related symptoms with activity.
• A creaking sensation (crepitus) when using the tendon, which is generally unpleasant and painful.
• Worsening of symptoms at night and when getting up in the morning.

Tendinopathy can present progressively and can be described in the following 4 phases:

• In the first, the athlete feels pain after physical exercise, as they cool down
• The second stage or phase occurs when the tendon hurts before and after sport, but the pain disappears during exercise; this is the last phase in which the tendinopathy still allows sport
• In the third phase, the tendon hurts before, during and after physical exercise, and does not allow normal sporting activity
• In the fourth phase, a tendon rupture has occurred, on the basis of a degenerated tendon

However, the presentation can also be acute or abrupt: during physical exercise, the athlete feels a sharp pain in the tendon. This indicates that, at the very least, there is a partial tendon tear, and from that event onwards the affected tendon is painful.

So how is tendinopathy treated? Should you stop sporting activity?

Sporting activity should never stop because of a tendon. The tendon is a fully adaptable, trainable structure capable of hypertrophy, metabolically active and acting as a transmitter and disperser of forces.

In the world of sport, muscle pathology and injury are the main problem. If we add to that the fact that the tendon is attached to the muscle and that the weakest area is the muscle-tendon junction, where the muscle always tears, the problem is magnified even further.

In fact, treatment consists of modifying or controlling the load and, of course, being patient: the recovery protocol for tendinopathies varies from tendon to tendon. We must be clear that the tendon does not need rest: the tendon needs a controlled load. That does not necessarily mean reducing it, but adapting or changing it. For example, your coach has scheduled sets of 200 metres uphill. Well, it may not be necessary to change the 200-metre sets, but if there is pain, it may be better to do them on flat ground instead of uphill. It is about trying to see where the problem with that tendon lies, since exercise can be done with minor discomfort.

We must start from the premise that reaching a diagnosis of tendinopathy is a significant challenge. Most of the time, when you know you have a tendinopathy it is because it hurts, but by the time the pain starts we have probably been carrying the condition for months. If you have no pain, unless you have previously had an ultrasound screening and can see the tendon is damaged, you cannot know whether you are developing a tendinopathy.

As for preventive measures, first of all you have to know yourself. An athlete, however amateur, must know themselves. That is essential. They must know whether they have a leg alignment issue, whether they have flat feet, etc. Know yourself, see where problems might arise and, from there, try to correct them, always through a controlled and progressive load that the tendon can manage well. It is not only about correcting leg-length discrepancies or gait problems; it is also about training progressively, with appropriate rest time and the right equipment… If we do this, not only will we avoid tendinopathy, but on the contrary, that tendon will withstand more and more, and better.