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Tendinopathies. A brief.

3rd Oct, 2022

Key Points

  1. Tendinopathy refers to a non-rupture injury in the tendon, whereas tendonitis refers to inflammation in the tendon
  2. Tendinopathy develops from repetitive overuse of the tendon before it has fully healed
  3. Diagnostic imaging is a useful tool to visualise the structure but cannot solely be used to diagnose tendinopathy

What is tendinopathy? Or is it tendinitis or what?!

If you’ve searched up anything along the lines of ‘tendon pain’, you would have come across these 2 terms: ‘tendinopathy’ and ‘tendonitis’, leaving you more confused than before you searched it up. Are they the same thing? Well, kind of. They are both terms used to generalise a pain or swelling tendon. Tendinopathy is the umbrella term to indicate a non-rupture injury in the tendon, and tendonitis refers to inflammation in the tendon.

What is the function of the tendon?

The tendons in our body are what connect muscle to bone. Tendons transmit force when our muscles contract in order to produce movement and are hence built to withstand heavy loads. 

Why does a tendon…cause pain?

Our tendons are designed for load-related activities, but repetitive loading beyond its physiological capacity will lead to a vicious cycle of injury, inflammation, and repair. Subsequently, this leads to pain and swelling which we classify as tendinopathy. With the accumulation of poor-quality repair tissue in the tendon, patients with tendinopathy find themselves in this cycle of chronic and acute-on-chronic pain as they try to get back to activity with a deconditioned tendon that has not been healed properly.

How does tendon pathology develop?

When our tendons are injured, they produce a biochemical inflammatory response which increases with prolonged exposure to overuse. Based on studies that observe how tendons respond to overuse, we learn that repetitive release of inflammatory and reparative mediators is the cause of tendinopathy development. This is why tendon pathology is also referred to as an overuse injury, because increased inflammatory activity is more prominent in injured tendons.

What are some of tendinopathy’s classification? 

Tendon pathologies can be further classified based on their pathophysiological features because not all tendinopathies are the same. There are 5 clinical features of tendon injuries:

  1. Time
    • Acute
    • Subacute
    • Chronic
    • Acute on chronic
  2. Tissue affected
    • Tendon
    • Enthesis
    • Paratenson
    • Tenosynovial sheath
  3. Additional features
    • Objective assessment based on presentation
  4. Degree of tissue disruption on cross-section at any site
  5. Underlying (risk) factors
    • Intrinsic risk factors
    • Extrinsic risk factors
    • Medical conditions

What are some intrinsic or extrinsic factors associated with tendinopathy?

Risk factors can be classified as intrinsic or extrinsic. Intrinsic risk factors refer to factors within the patient, such as biomechanics, age, and adiposity. Extrinsic risk factors refer to external  factors that directly affect the patient, such as excessive volume, speed or magnitude of loading, environment, and poor-quality equipment.

Smoking is also a risk factor as it is associated with poorer tendon histology than that of non-smokers.

Adiposity is a risk factor for tendinopathy as evidence shows an association between higher Body Mass Index (BMI) levels and increased risk of tendinopathy. 

How is tendinopathy usually diagnosed?

A hallmark feature of tendinopathy is localised pain that is aggravated with loading of the tendon. Therefore, tendinopathy is usually diagnosed after a physical examination, but diagnostic imaging may be used if the case is complicated, an appropriate rehabilitation program has been implemented but failed, or a differential diagnosis needs to be excluded.

Why does it need to be diagnosed properly?

Tendinopathy is very prevalent and can hinder the capability of an individual to lead an active and healthy life. When diagnosed properly, rehabilitation can then begin in order for the person to return to activity as soon as possible.

Will imaging tell us everything?

Diagnostic imaging does not tell us everything about tendinopathy but it can show us the structure for better visualisation. A clinical interpretation of a diagnostic image cannot be made without context such as location and distribution. Not to mention that there is a limited relationship between structural disorganisation and pain, and a poor correlation between presence of pain and pain severity. Not to mention, tendon pain is not solely caused by local tissue changes, hence while an image is able to let us visualise the structure, it is unable to explain the cause of pain.

Unsure of what to do? Contact us to speak to our Physiotherapist who will be able to ascertain the source of pain and have it addressed early!

DISCLAIMER: These advice and exercises should not replace the need for a consultation with a Physiotherapist especially if your condition doesn’t improve. Therapeutic exercise should be carefully selected to suit your condition.

Ref: 

Docking, S. I., Ooi, C. C., & Connell, D. (2015). Tendinopathy: Is imaging telling us the entire story? Journal of Orthopaedic & Sports Physical Therapy, 45(11), 842–852. https://doi.org/10.2519/jospt.2015.5880 

Scott, A., Backman, L. J., & Speed, C. (2015). Tendinopathy: Update on pathophysiology. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 833–841. https://doi.org/10.2519/jospt.2015.5884 

Vicenzino, B. (2015). Tendinopathy: Evidence-informed physical therapy clinical reasoning. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 816–818. https://doi.org/10.2519/jospt.2015.0110

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