Managing Tendon Pain

What is Tendon Pain?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder,elbow, hip, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of repetitive tendon overloading.

Tendinitis (or Tendonitis): This actually means “inflammation of the tendon,” but inflammation is actually only a very rare cause of tendon pain. Many health professionals still use this term out of habit.

The most common form of tendinopathy is tendinosis. Tendinosis is a noninflammatory degenerative condition that is characterised by collagen degeneration in the tendon due to repetitive overloading. These tendinopathies therefore do not respond well to anti-inflammatory treatments and are best treated with functional rehabilitation. The best results occur with early diagnosis and intervention.

Managing your Tendon Pain

1) Do not rest completely
Some rest is needed, but total rest is bad. Resting decreases the tendons ability to do its job. Although it may help your pain initially, it will not help your long term recovery. Your physio will advise you on what activities you can continue and how much of them to do.

2) Do not have injection therapies
Injection therapies, such as cortisone, have not been shown to have good long term effects on tendon pain. In fact, it has been shown that they increase the chance of your pain coming back and make your tendon weaker. Injections are a last resort to be tried if conservative treatments have failed, and repeated injections are definitely not encouraged.

3) Do use the traffic light system for exercise
This system is a way for you to identify what activity is okay to continue and which you should stop doing. Monitor your pain during and for the 24 hours after activity in a scale from 0(no pain) to 10 (worse pain).
Green 0-3 out of 10 = okay to continue, will help strengthen your tendon.
Yellow 4-5 out of 10 = okay to continue but in limited amounts, too much will irritate your tendon
Red 6-10 out of 10 = you should not be doing this activity, it is too much load

4) Do not stretch or massage the tendon
Stretching and massaging will make your tendon worse by compressing it against the bone. Tendons really do not like being compressed, it is what makes them problematic to begin with. Instead try rolling the muscle belly (not the tendon) using a ball or foam roller.

5) Do participate in a graduated strengthening program
The tendons job is to store energy and transfer force from our muscles to move the bone/joint. Your tendon is sore because it is not tolerating your current work load. The most important part of your recovery is increasing your tendons capacity to tolerate work load. This means we have to gradually increase the difficulty of the exercises you do at home to slowly put the tendon under more load. This is a slow process and depending on the sports or exercise you do may take anywhere from a few weeks to several months.

6) Do not stress about your ultrasound or MRI results
Diagnosing tendon pathology on an ultrasound is not 100%reliable. In fact, most middle aged people with no pain will still have features of tendinopathy on their ultrasound. There is no scientific evidence that there is direct correlation between the degree of the pathology and your pain levels, or how long your recovery will take.

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