What is tendinopathy?
Tendinopathy is really a generic term to describe pain coming from a tendon. There is a huge variability on how to diagnose it. From pain on palpation, loading of the tendon, subjective reporting or via imaging. As well as variability on where it is felt – for example the achilles, foot, knee, forearm or thumb.
So why is it painful?
This is the tricky part. For a long time it was believed that the pain must be purely due to a structural problem with the tendon. However this does not help to explain why some individuals appear to have healthy tendons on imaging but still have pain. Conversely why other individuals have apparently pathological tendons on imaging without pain. Which again demonstrates the huge variability of this condition. There is evidence to suggest changes in sensitivity of the tendon tissue and nervous system has a role. In particular if you’re suffering persistent pain (> 3 months). Which would explain ongoing pain with loading and exercise.
Exercise as a treatment
Exercises that load the tendon are effective in the management of the condition. However there is always an ongoing debate on the type, volume and frequency. With little regard to beliefs, fear and behaviour around pain. If treatment fails the application of the exercise must be incorrect.
Research has tended to focus on the exercise prescription rather than the individual as a whole. Self efficacy, patient expectations and perceived control of outcome are all crucial in recovery. If you are able to continue to engage in rehabilitation despite adversity a successful outcome is more likely. Which basically means you believe in your ability to maintain your exercises (or activities) despite a flare up of pain. Through effective self management and appropriate pain responses.
It is usually inappropriate responses that maintain this sensitivity of the tendon. You may reduce your activity to avoid pain. Become more sedentary – which ultimately has the potential to increase pain with activity.
Having pain is a normal part of the recovery process when exercising. Understanding how this will lead to a positive outcome is key. Physiotherapy can be very useful in guiding someone through this process. Helping to build self-efficacy and improve the ability to control, then ultimately, resolve the pain.