There are basically two ways of injuring a tendon.The tendon can tear either partially or fully after an acute incident, or it can become damaged over time from overuse. This latter injury is often referred to as Tendonitis. Pain often comes on gradually and may sometimes ease after warming up before exercise. However, pain and stiffness will generally return later as the body cools.
What is Tendonitis?
There is, however, some confusion over the appropriate name for this kind of condition. The word tendonitis, or tendinitis, literally means inflamed tendon. Whilst this is the most popular and commonly used term, true tendonitis is rare. Inflammation in the actual tendon is not usually found in samples.
Instead, the term 'Tendinopathy' is more frequently used to cover a range of tendon injuries. These include Paratenonitis conditions, which are overuse injuries to the paratenon which surrounds the tendon. These include Tenosynovitis (such as De Quervain's), Peritendinitis and Tenovaginitis.
Clinically it is impossible to determine between these conditions. This can only be achieved through further investigations such as MRI scans or biopsies. Definite diagnosis is not normally necessary, as treatment regimes are much the same.
Symptoms of an overuse tendon injury usually include:
- Pain which comes on gradually over a period of time.
- Pain may be worse when you start exercising and then ease off as you warm-up, only to return later.
- The tendon often feels stiff after periods of rest or in the mornings.
- The tendon may appear thicker than usual and maybe red.
- It is tender to touch the tendon.
- There may be lumps, called nodules within the tendon.
Treatment of all of these overuse tendon injuries will follow a very similar pattern. Whilst the initial treatment may aim to reduce pain, stiffness, and swelling, in order to completely correct the problem, any underlying causes, such as training errors (commonly too much too soon) or biomechanical problems (such as overpronation) must be addressed.
- Rest from any activities which aggravate the condition.
- Apply cold therapy to ease pain and swelling/inflammation.
- A therapist may use sports massage to relax the muscle. They may also apply a technique known as 'frictions' to the tendon to initiate the healing process.
- A therapist may also use electrotherapeutic treatments such as ultrasound.
- Acupuncture is thought to be useful in tendon injuries.
- Stretching exercises should be used to stretch out the tendon and muscle and avoid/correct any loss in motion.
- Eccentric strengthening exercises should be introduced.
Eccentric exercises are those which cause the muscle to contract, although the muscle lengthens, rather than shortening as it contracts. These exercises are performed with gravity and the aim is to control the downward movement. An example of this is a heel drop for the Achilles tendon. Standing on a step with the heel off the back of the step, rise up on to the tiptoes and then slowly control the downward movement, dropping the heel below the level of the step.