Tendon pain is a common condition that we treat and manage at Ellenbrook Physiotherapy, especially during this time of year with the sports that are in season and as people in the community start to train for events such as City to Surf.
Over recent years there have been many developments in the research and understanding of tendinopathies which have shaped new and more efficient ways of managing tendon pain.
Below I have tried to summarise some of these new ways of thinking and hope that if you are suffering from tendon pain they help you to better understand what you can do to improve it.
Tendons do not improve with rest
To improve tendon pain and function, you need to improve its ability to take load and resting it is not helpful as it simply decreases the tendon’s ability to manage load (Cook 2017). On the flip side, using the “no pain, no gain” mentality when trying to settle and improve your tendon pain is not useful. Modifying a tendon’s load to an amount that it can tolerate and then gradually increasing its load is vital (Maliaris 2015).
Exercise rehabilitation is the main treatment and passive treatment as an adjunct treatment can provide good symptom relief
Any treatment that does not improve the tendon’s ability to tolerate load is not helpful long term, however hands on therapy techniques can assist In the short term to provide some pain relief and a window of opportunity to start structured exercise rehabilitation (Cook 2017).
Recent research does not show that injection therapies are not useful long term for tendinopathy management. As a general rule, you should not inject a tendon unless it has not responded to conservative management and an exercise rehabilitation program (Maliaris 2015).
As part of a tendinopathy treatment and management plan at Ellenbrook Physiotherapy, we would usually incorporate some hands of therapy initially to assist with symptom control and aim to start some form of exercise rehabilitation as soon as possible as we know that ultimately a structured exercise rehabilitation program will be what helps it best.
At Ellenbrook Physiotherapy we believe in empowering you to better understand and manage your condition. We have access to fantastic gym rehabilitation and clinical Pilates facilities on our premises and offer a range of options in regard to supervised exercise sessions and independent rehabilitation gym memberships. Please don’t hesitate to ask us for further information.
You should not stretch your tendon
Often before someone seeks professional advice for their tendon pain, they try to manage it at home and one of the first things people commonly say they have tried to do it stretch it.
Stretching a painful tendon usually tends to provoke it and increase pain levels (Cook 2017) therefore soft tissue therapies such as massage and dry needling can be more helpful because they alleviate muscle tightness without stretching the tendon itself. There may be foam roller or ball releases you can do to help alleviate any associated muscle tightness without stretching the tendon itself. Please ask your physiotherapist for further information.
Try not to be worried about medical imaging findings
As with most musculoskeletal conditions, often pathology identified on imaging rarely matches someone’s reported pain levels. In clinical practice, medical imaging findings are often poorly correlated with how someone clinically presents and are not useful predictors for their prognosis.
Sometimes medical imaging findings can unnecessarily scare you and make you more hesitant to load your tendon which does not help your recovery (Cook 2017). There is strong evidence to sow that even the most pathological or degenerated tendon can respond well to correct management and controlled, gradual exposure to load (Cook 2017).
It is interesting to note that people who have absolutely no tendon symptoms whatsoever can have pathological or degenerative findings in their tendon on imaging (Maliaris, P 2015).
Try to be patient
Unfortunately there is no ‘quick fix’ to improve tendons, nor are there any ‘short cuts’ when it comes to exercise rehabilitation. It is important that you take the time that your tendon requires to gradually increase its load tolerance and capacity for activity (Cook 2017). You will be rewarded for your efforts with a better long term outcome.
At Ellenbrook Physiotherapy, we realise that not everyone has the same level of interest in exercise, nor do they have the same time available each day to dedicate to exercise rehabilitation. We hope that with the wide array of rehabilitation options we have available, we can find something that suits you and will help you to achieve your goals.
In summary…
Although tendon pain can be debilitating at times, it is not permanent and with the right physiotherapy management there is always potential to improve it.
Current research identifies that exercise-based rehabilitation is the best treatment for tendon pain (Cook 2017). Exercises that may be appropriate for one person may not be suitable for another so it is crucial that a qualified health professional correctly assesses you and helps to guide you along the safest, most appropriate and most effective rehabilitation program for your particular case.
Using current best practice, at Ellenbrook Physiotherapy we aim to progressively increase your tendon’s ability to tolerate load to restore its normal function whilst always being mindful of your pain and symptoms. For further information and advice on how to manage your tendon pain, please don’t hesitate to contact us.
Erin McLoughlin
Physiotherapist
References
Cook, J 2017. 10 Things Not To Do If You Have Tendon Lower Limb Tendon Pain, La Trobe University, URL = <http://semrc.blogs.latrobe.edu.au/10-things-not-to-do-if-you-have-lower-limb-tendon-pain/>
Maliaris, P 2015. 9 Tendinopathy Truths You Must Know, Complete Sports Care, URL = <http://www.completesportscare.com.au/2015/08/9-tendinopathy-truths-must-know/>
