Tendinopathy is a generic descriptor of the clinical condition of both pain and pathological changes in and around tendons arising from over-use. These pathological tendons typically show either absent or minimal inflammation, loss of tightly bundled fibers (fraying) and/or thickening, which are indicative of a weak and inefficient structure. Although inflammation may play a roll in the initiation, evidence indicates it does not contribute to the propagation and progression of the disease suggesting anti-inflammatory medications will be of little help.
Tendon over-load can be an acute process with an obvious mechanism or chronic long-term process, which results in incremental weakening (micro trauma and degeneration often below injury threshold). The chronically overloaded tendon may finally reach a point of failure by what seems to be a trivial event or gentle activity. In both the acute and chronic overloaded tendons a healing response is initiated, however it is often ineffective in symptom resolution for particularly the chronically overloaded tendon for a number of reasons:
Tendon and tissue structure are altered making it ineffective, weak and unable to adequately respond and adapt to load over time
Biomechanical factors contributing to tendon overload are not addressed
Training factors contributing to tendon overload are not addressed
Tendon load management and stage of tendinopathy (early reactive, disrepair or late degenerative) are central to pain modulation and overall recovery. Management will often involve strategies to unload and settle tendon pain through taping, soft tissue massage, needling or orthotics in conjunction with a tendon loading program, which will be designed to progressively strengthen the weakened tendon. Advice and exercises will also be prescribed to address the training or biomechanical factors, which may have contributed.
Increased symptoms such as pain or stiffness following activity or the following morning are suggestive of overload and need to be avoided in order for pain to settle and so that positive tendon adaptations can take place.