What’s in a name?

If you have had tendon pain for a while, you have probably googled it and been left feeling confused. There are several terms that have been used in the past to refer to tendon pain. So, let’s clear that up first and ensure we’re on the same page.

Persistent tendon pain is known as Tendinopathy.

Previously other terms such as tendinitis – ‘itis’ meaning inflammation, or tendinosis – ‘osis’ meaning condition or disease, have been used to describe tendon pain. However, with the development of imaging and research we now know that there’s very little inflammation involved with persistent tendon pain and following the 2020 International Symposium Consensus ‘tendinosis’ was ruled as being ‘a term without a clear definition’.

It further encouraged practitioners to use the term tendinopathy for all tendon pain that gets worse with activity.

It does get slightly more complicated than this with the development of the tendinopathy continuum. This highlights three key phases along a continuum where a tendon moves from Reactive Tendinopathy through Tendon Dysrepair to Degenerative Tendinopathy as shown below.

Where your tendon sits on this continuum can inform the best treatment and rehabilitation methods. It can also better inform timescales for becoming pain-free.

What is it & why does it occur?

During & for a short period after activity cells in your tendon breakdown. After activity for anything up to 72 hours your body works to regenerate these cells. Also, termed degradation and synthesis.

Collagen degradation (breakdown) and synthesis (repair) occur following acute bouts of exercise. This is how tendons adapt & become stronger through training just like any other structure in the body. Studies have shown that tendons can respond by demonstrating changes in their elasticity, viscosity, length, stiffness, compliance & thickness.

Clever huh!?

But to do this effectively they have to go through the process of recovery, regeneration, and repair after every acute bout of activity. This takes time, up to 72 hours in some instances if a session has been particularly stressful to the tendon in question.  

Tendinopathy occurs when there is an imbalance between cell degradation and synthesis.

Insufficient recovery may be pivotal in altering the ‘collagen synthesis-breakdown cycle’. The tendon enters a catabolic state, where the circulating hormones and chemicals are causing cell breakdown without the stimulation of the anabolic processes that cause the repair. And as such tendinopathy develops.

If this process continues without intervention the tendon will move along the continuum. How we approach your tendon pain will differ according based on a number of factors illustrated below.

What can you do?

How your tendon pain is approached should be individual to you. I will cover some key dos and don’ts in more detail in part II. But below I have broken down the key components of my assessment and treatment session.

1.       Place your tendon pain on the continuum – Firstly, finding out how long you have had the pain, when the pain occurs & what specific activities aggravate it, help me to place your tendon on the continuum & ensure we prescribe the right level of rehab.

2.       Discuss what you are trying to achieve – If you’re midway through training for a marathon we would approach your treatment & rehabilitation differently to if you have pain at work or you’re in between competitions. So understanding what we’re aiming for will inform an effective plan.

3.       Next we discuss what you CAN do. Stopping activity all together is the worst thing you can do for tendon pain. By making adaptations based on the current level of aggravation, we can find your pain-free baseline and stick with it.

4.       Make an achievable, individualised rehabilitation plan – Lastly, together we will develop a plan. Whether you’re a gym goer or home exerciser this will dictate how we schedule the rehab and even the exercises we choose.

I’m busy working away at Part II of this tendon pain blog……this link will be active as soon as it’s published. But if you would like to talk to me about your tendon pain complete the contact form now and we can arrange a time to chat.