What is a tendon?

A tendon is a bunch of fibres made from connective tissue that attached muscles to bones. It is made of the same tissue as a ligament, but a ligament attaches bones to other bones.

What is tendinopathy?

Tendinopathy is when the tendon become inflamed (tendinosis), usually over time, which is different to a strain, which are usually acute (tendinitis). The most common areas that develop tendinopathy are those that get used the most use, shoulders (rotator cuff), elbows (common origin forearm extensor or flexors, tennis or golfers’ elbow), wrists, knees (patella tendon) and Achilles tendons.

How does this happen?

For a tendinosis it seems to be related to chronic overload and resultant collagen changes. While at first there may be some inflammation, over time the changes are more related to poor healing by collagen fibres rather than ongoing inflammation. When small samples of tendons with tendinosis are viewed under the magnification the collagen fibres do not line up correctly.

How do I fix it?

There are many ways to help the recovery of tendons for tendinopathy. The most important are rest and change the way that you do things. It can be very worthwhile to see a doctor with musculoskeletal experience, a physiotherapist or occupational therapist to assess your ergonomics and your biomechanics. By simple adjustments to your work space or altering who you complete an action in your sport this may reduce or stop the tendinosis from continuing.

Bracing the area, stretches and icing the area can all also assist with decreasing the discomfort and improve recovery times.
A type of exercise called eccentric strengthening has been shown to assist with both recovery and prevention of reoccurrence. This is done by lengthening the muscle while under load. Your doctor or physiotherapist can demonstrate how to do the right exercise for you.

Other Treatments

The following treatments have not been studied well enough for there to be strong evidence or consensus of opinion from experts. Please discuss them with your doctor or physiotherapist before trying.

• Extracorporeal Shock Wave Therapy: is when sound waves are used to stimulate cells to help with healing. There also may be some reduction in pain.
• Low-level laser therapy (LLLT): in this a laser id used to stimulate the area. It is usually used in conjunction with more accepted treatments. It is hard to identify the amount LLLT contributes to the recovery.
• Iontophoresis and phonophoresis: this uses ionizing current or ultrasound to assist steroid or anti-inflammatories to the affected area. There are no good studies to assess how good this is compared to other treatments
• Friction massage: massage with fingertips to the affected area.
• Ultrasound: this treatment is widely used by many practitioners, including physiotherapists, however, there have been no good studies to endorse its widespread use. There are some smaller studies which showed some promise for tennis elbow and calcific tendinosis of the shoulder
• Hyperthermia: the studies completed were measured against other unproven treatments (ultrasound therapy). There remains no strong evidence for its use.

How quickly will I get better?

Tendinopathies can take some time to settle. Patience and completing the exercises that you have been given will give you the best chance at a faster recovery. Most tendinopathies can take from 3 to 12 month to recover.