Tendon pain: everything you need to know 

Have you been told that you have tendonitis or tendinopathy? Has it been frustrating, painful, or not going away?
In this article I will be covering:
What is tendinopathy?
What causes tendinopathy?
Will tendinopathy ever get better?
What is the BEST way to treat tendinopathy?

Now for background I’ll be using tendinopathy as an “umbrella term” for tendinitis, tendinosis, and tendinopathy. Tendinopathy refers to various types of tendon pain and “overuse” conditions. Tendon pain is common and can occur in different parts of the body.(1,2)
Several common ones include:
-Golfer’s Elbow
-Tennis Elbow
-Jumper’s Knee (Patellar Tendinopathy)
-Swimmer’s Shoulder (Rotator Cuff)
-Achilles tendinosis
-And many more!

What is tendinopathy or tendinitis?
For background, tendons are a connective tissue that connects muscles and bone. They function to absorb and transfer forces during movements such as running, walking, or lifting.
What’s amazing is that tendons have the unique ability to adapt and change in response to mechanical loading. This could be anything from a runner that ups their mileage in training for a race to a blue collar worker at a factory who’s had to be pulling extra shifts.(3)

Sometimes if these changes happened too quickly the tendon can become “overwhelmed” leading to pain and irritation. This manifests itself in pain with movement and activity that is often nagging and persistent.(4)

What causes tendinopathy ?
“Tendinopathy” is a general term for changes in the tendon associated with pain, reduced tolerance to loading and activity, change in the tissue structure. Tendinopathy occurs when the tendon fails to adapt or fully heal from a new load (or activity) and into a new capacity ( ability to respond). Common symptoms include dull muscle pain, stiffness in the morning, and pinpoint pain with movement.

Does tendinopathy ever go away?
If you’re reading this you’ve probably wondered how long it will take to go away. While your unique situation will vary, tendon pain takes time and patience. In general, tendon pain is something that takes “weeks to months” instead of “days to weeks” to fully heal. On average, with proper treatment (more on that below), tendinopathy can take several months for full improvement.(5,6)

How do I treat tendon pain?
Before we talk about what is the BEST way to treat tendinopathy let’s examine what is not helpful. Rest, long term steroid injections, and prolonged NSAID use (ibuprofen) have little scientific support in treating tendinopathy.(7)

The research has shown that progressive exercise and rehabilitation is the best way to treat tendon pain. Your health care provider should take into account your activities, load, and intensity level to build a rehab program for you! Gradually, this rehabilitation will build the strength and capacity of the tendon in order to get you back to what you want to do or need to do in your life. Additionally they should be able to vary it depending on your level of symptoms and have a clear plan on how to return to activity or your sport.

Other treatments such as soft tissue therapy, dry needling, or joint manipulation can be useful for short term pain control. While helpful, they are meant to be an adjunct to care, the emphasis will be on progressive loading at home.(8)

Do I need surgery?
One other major concern I hear often is “do I need surgery?”, and for the vast majority of patients the answer is a firm NO. In fact, surgery for tendon pain has been shown to be no better than active care and is only to be considered after 12 months of exercise focused treatment.(9)

What’s the bottom line?
Tendonopathy is tendon pain due to overload or overuse.
Surgery and rest are not recommended treatment.
Tendon pain requires patience and proper rehab to fully recover.

If you have any questions about your specific tendon pain or in getting treatment that is right for you, contact us at 513-531-2277 or schedule here:  https://www.norwoodchiropractic.com/pages/book-an-appointment

ABOUT THE AUTHOR
Tyler Kemp is the current preceptor at Norwood Chiropractic and is in his final months of training as a chiropractic physician. His previous training before coming to our Mason office has included rotations at Mercy Hospital (St. Louis), a federal medical center (Affinia Health) , and a sport rehab office. When not in the office, Tyler enjoys running and exploring Cincinnati with his wife Stephanie and their dog Rose.

 
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 REFERENCES:
Bohm S, Mersmann F, Arampatzis A. Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Med Open. 2015 Dec;1(1):7. doi: 10.1186/s40798-015-0009-9. Epub 2015 Mar 27. PMID: 27747846; PMCID: PMC4532714.

Xu Y, Murrell GA. The basic science of tendinopathy. Clin Orthop Relat Res. 2008 Jul;466(7):1528-38. doi: 10.1007/s11999-008-0286-4. Epub 2008 May 14. PMID: 18478310; PMCID: PMC2505234.

Bohm S, Mersmann F, Arampatzis A. Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Med Open. 2015 Dec;1(1):7. doi: 10.1186/s40798-015-0009-9. Epub 2015 Mar 27. PMID: 27747846; PMCID: PMC4532714.

Turner J, Malliaras P, Goulis J, Mc Auliffe S. "It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away." A qualitative study exploring individuals' beliefs and experiences of Achilles tendinopathy. PLoS One. 2020 May 29;15(5):e0233459. doi: 10.1371/journal.pone.0233459. PMID: 32469914; PMCID: PMC7259496.

Mulvad B, Nielsen RO, Lind M, Ramskov D. Diagnoses and time to recovery among injured recreational runners in the RUN CLEVER trial. PLoS One. 2018 Oct 12;13(10):e0204742. doi: 10.1371/journal.pone.0204742. PMID: 30312310; PMCID: PMC6193581.

Vaquero-Picado A, Barco R, Antuña SA. Lateral epicondylitis of the elbow. EFORT Open Rev. 2017;1(11):391-397. Published 2017 Mar 13. doi:10.1302/2058-5241.1.000049

Gaida JE, Cook J. Treatment options for patellar tendinopathy: critical review. Curr Sports Med Rep. 2011 Sep-Oct;10(5):255-70. doi: 10.1249/JSR.0b013e31822d4016. PMID: 23531972.

Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008 Jul;466(7):1539-54. doi: 10.1007/s11999-008-0260-1. Epub 2008 Apr 30. PMID: 18446422; PMCID: PMC2505250.

Challoumas D, Clifford C, Kirwan P, Millar NL. How does surgery compare to sham surgery or physiotherapy as a treatment for tendinopathy? A systematic review of randomised trials. BMJ Open Sport Exerc Med. 2019 Apr 24;5(1):e000528. doi: 10.1136/bmjsem-2019-000528. PMID: 31191975; PMCID: PMC6539146.

Tyler Kemp

Tyler Kemp

DC, Dry Needling Specialist, Acupuncture Certified

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