Tendon pain

We have all heard the word ‘tendon’. But do you know what it is?  Do you know why it can be often the source of pain and limitation? Below is a brief summary;

What is a tendon?

A tendon is a tissue that connect the muscle to bone and allows the joint to move. Tendons have the ability to absorb and release energy for movement to occur. Tendons are like springs. The tendons are designed to load up and store energy for when you’re about move.

What is Tendinopathy?

Tendinopathy is when the tendon has become overloaded/ overused or even underused! What can happen is a breakdown of the collagen within the tendon. The cause of tendinopathy has been linked to the repetitive energy storage and release with excessive compression.

Common areas for tendinopathy to occur

  • Achilles
  • Patellar (Jumper’s Knee)
  • Lateral Elbow (Tennis Elbow)
  • Rotator Cuff ( Shoulder)

Who is at risk of tendinopathy?

Anyone can have tendinopathy but typically those who are at risk of tendinopathy are:

  • Runners or Jumpers
  • People who do repetitive movements such as athletes or workers
  • Overweight
  • Diabetics
  • People with Altered lower limb mechanics

What is the Tendon Continuum?

Cook and Purdam (2009) proposed a concept of a continuum that demonstrates the process that a tendon can go through when load management is poor. When a tendon is loaded, it adapts by strengthening. Tendons if overworked respond by getting thicker to help deal with new stresses and microtrauma that have occurred.

  • Reactive Tendon – where there is a response from the tendon in which cells and matrix of the tendon get thicker. Can still be reversed to a normal tendon.
  • Tendon Dysrepair – In this stage, the tendon undergoes some structural changes that can still be reversed to a reactive tendon via modified loading. If the load is not managed, it will go into the last stage.
  • Degenerative Tendinopathy – Irreversible structural damage to the weakened tendon. The stage where cell death and matrix disorganisation occur in the affected portion of the tendon. Rehabilitation is still ongoing during this stage to prevent the loss of further tendon tissues.
  • Reactive on Degenerative – The outer unaffected part of an affected tendon has reached the reactive tendon stage.

Focus in Rehab

Tendinopathy rehabilitation is about load management. Rehab for tendinopathy is different for each area of tendinopathy i.e., treatment for rotator cuff tendinopathy is different from Achilles tendinopathy. Depending on where the affected tendon is, rehab would need to be tailored to focus on what the tendon needs to do.

  • Focusing on the tendons ability to tolerate loads and strengthening the muscles in the area
  • Once a tendon becomes degenerative, rehab is about maintaining the good healthy tissue around the degenerative portion.

At Aspire physiotherapy our physio’s are trained at identifying, treating, managing and resolving tendon problems.


achilles painelbow painpatella tendonrotator cuff tendontendon pain

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