Tackling Tendon Pain (The Basics Explained)

If you’re dealing with recurrent tendon pain, referred to as tendinopathy (sometimes tendonitis or tendinosis), you are likely feeling the frustration of this common overuse injury. 

The tendinopathy cycle normally goes something like this:

1. You’ve been dealing with progressive pain and stiffness. Usually, it hurts more with continued activity or moving after long periods of rest.
2. After taking a break from the activities that make it hurt and maybe even throwing some ice on it, it’s been feeling surprisingly better.
3. Optimistic that you’ve given your tissue enough time to rest and recover, you decide to go out for a jog, a hike, spend a full afternoon outside working in the yard, or go back to whatever activities that you have been sidelined from due to pain.
4. It feels great to do what you enjoy again, but as time passes you start to feel the nagging pain creep back up. Just like that, you are forced to take several days off to allow the pain to “calm down” so you can try again, hoping that something will soon change.

It may be tempting to lose hope when dealing with recurrent tendon pain- but it’s likely that you are leaving a lot of potential for healing on the table. This article will explain the basics of tendons, why ice and ibuprofen won’t cut it, and how physical therapy can help to resolve your tendon pain and get you back to doing what you love.

TENDON ANATOMY 101

Tendons are the structures that attach muscle to bone and function primarily to store and release energy. They are composed primarily of highly organized bundles of a protein called collagen, giving the tendon strength to withstand the very high forces necessary for our movement (see image below.) Each time a muscle contracts, the force produced must be transmitted through the tendon in order to pull on the bone and create motion. You can think of a tendon as an extremely strong rubber band. The capability for this tissue to stretch also allows it to store and release elastic energy, making our movement much more efficient. When tendons experience forces, they sense and respond at the cellular level by increasing production of the proteins that make them stronger. This adaptation means our tendons can get stronger over time, so that we can handle larger and more frequent forces.

HOW THINGS GO WRONG

If tendons are loaded excessively and repeatedly, collagen fibers are disrupted, which could trigger the onset of pain. An example of loading tendons excessively and repeatedly is when you increase running distance or increase workload too quickly. Overloaded tendons progress through a continuum of tendinopathy.¹ Early changes in the tendon during the “reactive stage” of tendinopathy include thickening of the tendon so that it may better withstand stresses. If handled properly, these symptoms can be short-lived. However, if tendon pain goes untreated and loading remains excessive, the tissue may progress to “degenerative”tendinopathy. In this case there are now small regions of dead tissue in the center of the tendon that are no longer capable of transmitting forces, leading to a weakened tendon. If you picture looking down the length of the tendon, this would look like a small island of degenerative tissue, much like the hole in the center of a donut. It is very important to seek treatment early on if you start to experience tendon pain, because progression into chronic degenerative stages may result in tissue changes that are much more difficult to treat.

WHAT WILL NOT HELP

• REST: In some cases, a period of rest and unloading of a tendon may be advisable with early tendinopathy. However, research has shown that loading the tendon through specific exercises is the most effective treatment for achieving prolonged improvements.­­² Tendons become stronger when they experience loading through a process called mechanotransduction.³ Without enough loading tendon can actually weaken, showing changes similar to those seen with overuse through a process called stress shielding, meaning that extensive rest without rehab is rarely beneficial.

• ICE and NSAID’s: While ice and NSAID’s (anti-inflammatories such as ibuprofen) can be useful for short-term pain reduction, they will not cure tendinopathy. Tendon pain is not primarily driven by inflammation as the medical field believed years ago, hence the moving away from the term “tendonitis” (-itis indicates inflammation). Therefore, attempts to reduce inflammation are typically not helpful in recovery. What will help is strengthening the tissue through exercise. With this said, these aids may still be utilized in some cases on top of exercise therapy if deemed appropriate. 

HOW IT IS TREATED

The key to tendon rehabilitation is progressive loading exercises that strengthen the tendon. The goal is to first reduce the pain to a tolerable level through specific exercises and identifying other contributing factors. Assessment will likely include identifying certain activities that place excessive strain on your tendon. From here, exercises will be focused on increasing the strength or “load capacity” of your tendon by facilitating the production and strengthening of collagen. As tendons adapt and remodel in this manner, they will be better able to handle the forces placed upon them during your everyday activities. Our physical therapist can identify the staging of your tendinopathy and determine the correct exercises to strengthen your tendon in a safe and progressive manner.

FIND RELIEF TODAY

Each body and case of tendinopathy is unique. Because of this, your treatment plan will be dependent upon the location and severity of your condition, as well as any other physical limitations you may have. At your initial appointment, you will undergo a thorough assessment in order to determine the optimal treatment for your unique presentation. Schedule an appointment with one of MTI Physical Therapy’s highly trained physical therapists today and let us help get you on your path towards long-lasting pain relief!