Tendon Pain: The Lowdown

To kick off our series on tendon pain, let’s start with the basics… what is a tendon?

The tendon connects muscle to bone, therefore allowing the muscle contraction to move a joint, and as a result, the most common way of damaging a tendon is overuse. The acute injuries are generally from a sporting injury whereas the chronic ones are a result of accumulation of small repetitive failures to heal within the tissue.

Tendon injuries, known as tendinopathies, are usually found where acute irritation occurs when the breakdown of an area of the tendon exceeds repair. The forearm extensors and flexor tendons (tennis and golfers elbow) and the Achilles tendon (attaching the calf muscles to the heel) are the most commonly affected.

When the tendon starts to stress and become injured, the collagen fibres of the tendon become disorganised and blood flow increases into the tendon from deeper fibres which increases the water content of the tendon. The tendon then becomes tight, restricted, thick and painful as a result of pain receptors becoming irritated by the damaged tissue. The injury can take place at the junction of the muscle fibres with the tendon itself, 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, which is designed to withstand a great deal of force and tension, will have become injured as a result of being chronically overloaded. Whether it's from playing too much tennis or golf without being warmed up and with poor technique or running too explosively on hard ground, once there is tendinopathy, it is important to get the balance right between rest and exercise of the tendon and the muscle 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 an increased probability of injury.

What are the key causes?

The main causes for tendinopathies are:

• Sudden increases in intensity and/or duration of activity (such activity can range anyway from playing golf to clicking your mouse!)
• 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 start with an ache which then eases with movement but becomes stiff or tender following exercise. Often patients continue with their activity and the problem remains fairly low level in terms of pain. However, the longer the tendinopathy continues, the more chronic and painful it becomes and the harder it is to treat.

So how can I treat/manage my tendinopathy?

At Not Just Backs, we have a specialised tendon clinic, where we treat the acute phase of tendinopathy with manual therapy and specialised exercises. However, tendons are notoriously difficult to treat as they have a poor blood supply, and so many end up chronic.

This is where our state-of–the-art extracorporeal shockwave therapy comes in. Using sound waves to heal the tendon, it is the only treatment to have been proven to actively heal tendons. Often we see people being recommended steroid injections, however these don’t heal a tendon but rather mask the pain and attempt to reduce the inflammation.

Please feel free to contact us at 01722 512 043 if you’d like to learn more about our specialised tendon clinic.