What is a tendon?
Tendons are bands of thick connective tissue which allows them to absorb energy and aid in proprioception, transferring large mechanical forces from muscle to bone. They continuously adapt to repetitive or sustained load allowing us to enjoy our favourite sporting and daily activities.
Tendons come in lots of shapes and sizes and this depends on the role of the muscle. Every muscle has a tendon on the proximal and distal end connecting muscle to bone.
The musculotendinous junction is the point where the tendon connects to the muscle and the point at which it attaches to the bone is called the osteotendinous junction.
When tendons aren’t tolerating the load you are giving them they can become annoyed and irritated, potentially leading to pain and functional limitation. This type of injury is called Tendinopathy.
Reactive tendinopathy - disproportionate stress which prevents a normal healing response, leading to a pain response
Tendon disrepair - disproportionate stress on the tendon continues, tendon attempts to adapt by increasing the protein molecules in the extracellular matrix and sprouting new blood vessels in the tendon
Degenerative tendinopathy - continued stress without load modification
Tendon’s Healing behaviour occurs in three stages:
Inflammation phase - initial response providing clotting to ruptured vessels
Proliferative and repair stage - fibroblasts and tenocytes enter, multiply and rebuild tendon structure
Remodelling phase - tendon adaptation, growth, thickness and length
How can Physiotherapy help?
Tendons best respond and receive mechanical stimulation to load input, especially eccentrically where the muscle is lengthening under tension. This allows the muscle to do the same amount of work, with less effort. An eccentric loading program, the best evidence based treatment when it comes to managing tendinopathies will be determined by the physiotherapist. Pain is acceptable during the exercise however each individual will tolerate a different threshold to load, depending on which stage the tendon is at. Educating our patients therefore plays a significant role in treating tendinopathies, grading your return back to normal activities and knowing how and when to regress or progress appropriately, whilst monitoring tendon pain response throughout your recovery.
If you are experiencing pain or limitations related to tendinopathy, please contact us to book and appointment with one our experienced Physiotherapists for treatment.