Tendinopathies
Tendons attach our muscles to bone (as opposed to ligaments which attach bone to bone). Tendon injuries, known as tendinopathies, are usually found where acute irritation occurs when breakdown of an area of the tendon exceeds repair. The forearm extensors and flexor tendons and the achilles tendon (attaching the calf muscles to the heel) are the most commonly affected which often leads to tennis or golfers elbow and painful achilles.
When the tendon starts to stress and become injured, the collagen fibres of the tendon become disorganised and arranged in a haphazard rather than linear alignment and blood flow increases into the tendon from deeper fibres which increases the water content of the tendon. Due to this tendon becomes tight, restricted, thick and painful as a result of bodies pain receptors (known as nociocepters) become irritated by the damaged tissue.
The injury can take place at the junction of the muscle fibres with the tendon itself, anywhere in the tendon 'belly', or where the tendon attaches to the elbow, heel or elsewhere.
In the vast majority of cases whether it is the forearm tendon or the achilles, the tendon is designed to withstand a great deal of force and tension and it can become injured as a result of being chronically overloaded. Whether it's from too much activity without being warmed up and with poor technique or running too explosively on hard ground, once the tendon is injured, it is important to get the balance right between rest and exercise of the tendon and the muscle(s) to which it is attached. Stopping all activity or over-resting, in the case of the achilles for example, will weaken the calf and associated muscles leading to cell change and increased probability of injury.
The main causes for tendinopathies are:
· Sudden increases in intensity and/or duration of activity
· Degeneration due to under use or weakening due to age
· Lack of stretching or sudden over-zealous stretching
· Achilles tendon - increased body weight, flat feet (over-pronation), poor footwear and running or exercising on hard surfaces.
Tendinopathies usually starts with an ache at the beginning of activity. This ache then eases with movement but becomes stiff or tender after exercise. Often the person then continues with their activity and the problem remains but fairly low level in terms of pain. The longer the tendinopathy continues the more painful it becomes and the harder it is to treat and will then be classed as “chronic”.
Treatment and management
When tendinopathies first arise, it is worth initially to apply the RICEE principle (Rest, Ice, Compression, Elevation and Exercise gently). If this doesn't help, do get the problem assessed by an Osteopath or another form of health practitioner to ensure that you get the appropriate treatment for your individual needs – both in terms of hands on treatment and advice about how to rehabilitate your injury.
Supports such as Epistraps (for tennis and golfers elbow) or orthotics/insoles (for achilles tendinopathies) are always good to help with initial pain relief as they work by taking a lot of strain off of the injured tendon however it is important not to become dependent on them.
If all else fails, you can be referred for an MRI either via your GP or privately or to a practitioner specialising in musculo-skeletal ultrasound imaging. These scans will inform you of the severity of the condition and will let you know whether you need further treatment including steroid anti-inflamation injections or surgery.