What is a tendon and Tendinopathy?

What is a Tendon and Tendinopathy?

A tendon is a strong band of fibrous tissue that connects a muscle to the bone. The role of a tendon is to transmit force between the muscle and bone and act a shock absorber especially in the lower limb.

Pathology or injury to a tendon is referred to as a tendinopathy. Colloquially, a tendinopathy can be described as an overuse injury to a tendon. Especially in the athletic population, tendinopathies can be extremely debilitating chronic injuries which adversely affect an athletes performance. Historically these conditions are poorly managed without physiotherapy guidance.

Anatomy of a Tendon

Note: previously the above pathology was referred to as ‘tendinitis’, however histopathological studies have indicated a lack of inflammatory cells in patients with tendon pain. The term tendinosis can also be utilised to describe overuse pathology of a tendon.

Common Sites of Tendinopathy:

Common sites for tendon pain include:

  • Achilles (heel) tendinopathy
  • Patella (knee) tendinopathy
  • Adductor (groin) tendinopathy
  • Rotator cuff (shoulder) tendinopathy
  • Elbow (Tennis elbow or golfer’s elbow)
  • Wrist/Thumb (De Quervein’s)

knee tendon shoulder tendon


The clinical symptoms of clients with overuse tendon pain include:

  • Pain free at rest and initially becomes more painful with use
  • Pain following exercise or activity
  • Pain the morning following exercise/activity, especially upon rising.
  • Athletes report an ability to “run through” the pain or the pain disappears once they “warm-up”. Despite this the pain returns (often worse) once they cool down
  • The athlete/client is able to continue to train/function fully in the early stages of the condition, which likely interferes with the healing process
  • Examination highlights local tenderness
  • Reduced muscular strength or function is apparent secondary to pain

Stages of Tendon Pain:

As proposed by tendon experts Jill Cook and Craig Purdam, tendon pathology should be considered as a continuum. In this light the early intervention can ‘reverse’ the symptoms and pathology of an inappropriately loaded tendon.

Stage 1:          Reactive Tendinopathy           An acutely overloaded tendon

Stage 2:          Tendon Dysrepair                   A worsening of tendon pathology with breakdown of                                                                the matrix of the tendon

Stage 3:          Degenerative Tendinopathy   Chronic tendon pain with areas of cell death and                                                                               collagen and matrix breakdown within the tendon.

tendon pathway

Risk Factors:

Risk factors for tendinopathy include:

  • Increased or excessive load on a tendon
  • Muscular weakness
  • Poor biomechanics or load strategies
  • Inappropriate extrinsic factors (ie shoe wear, ground surfaces, etc)

Physiotherapy and management:

Physiotherapy management of tendon pain is dependant on the location and role of that tendon (ie the management of tendinopathy’s in the upper limb differs from that in the lower limb). Several strategies will be employed by your treating physiotherapist to aid in the tendon recovery as highlighted in the continuum above. These include:

– Load management

– Static strengthening

– Progressive strengthening

– Biomechanical corrections

  • Equipment prescription (ie appropriate runners)
  • Taping or bracing as required

It is worth noting the below strategies have been shown to be detrimental in the recovery process of  tendinopathies:

  • Complete rest
  • Ignoring the pain
  • “Stretching” of the tendon

– “Compression” of the tendon

  • Massage of the tendon (note massage of the attached muscle may be beneficial)
  • Passive approaches (ie injections – especially without the addition of appropriate exercise program)
  • Not adhering to exercise and load advice as guided by your therapist

Evidence supports the fact that exercise based rehabilitation is the best treatment for tendon pain. At Total Physiocare we specialise in the accurate diagnosis, management and return to activity or sport for clients presenting with tendinopathy. Call us now to make an appointment.

jumpingcatching theraband

Blog by Christian Bonello (Physiotherapist)

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