Tendonitis, tendinosis, tendinopathy... There have been many words to describe issue with tendons over the years but does that help you understand what they are and what to do about them? Probably not!
The terms used above have often been (incorrectly) used interchangeably to describe tendon pathology and loosely refer to types of cellular activity within tendons in response to stress. Now I know you haven't come here for a lesson in human cellular biology so I won't bore you too much with the explicit details but just understand that if your pain has been diagnosed as one of the above mentioned terms then physiotherapy is most likely what you need to start treat it.
Tendons are the part of the muscle that join the muscle onto the bone. When a muscle contracts the force that's produced gets transferred through the tendon onto the bone. Understandably, the load that passes through a tendon can be very high but will depend on the size of the muscles and the size of the tendon. Now, if a tendon is prepared to deal with these high forces because it is healthy, it has been trained to do so and there are no other health issues that might affect a tendons ability to do its job then it copes just fine and remains pain free. However, if you're reading this blog then there's a good chance that that makes no odds to you because you may well have pain from the tendon! So the problem comes when a tendon is asked to do something it is not prepared to do it has the potential to become painful.
There is no doubt about it, tendons can become very painful, very quickly and, even though it is a common presentation, can have a huge impact on your daily life and can affect work and sleep quality. The pattern usually presents as pain starting around a tendon the evening or morning after you have done something outside of your normal routine. As physiotherapists we get used to looking out for certain patterns or situations in which we know tendon overload is more likely to have occurred. Things I hear on a regular basis are that clients have recently started doing things like running or doing HIIT workouts and developed pain around the heels (Achilles' tendon) or knees (patella tendon) or those that have moved house, lifted lots of boxes then noticed shoulder pain afterwards (rotator cuff tendons). These are simply common examples but they do present evidence of tendons being asked to do something they have not had adequate training to do well.
They say tendons don't like holidays or big surprises. If you have never done something before, and then throw yourself into it with no preparation, this would constitute a big surprise and a tendon has the potential to start grumbling. By the same token, if you have previously done an activity, had a period away from said activity (holiday), then launched yourself back into it again, the tendon can be equally as unhappy about that.
The way I start managing tendon issues is by asking my clients to view tendon pain as a balance between load and capacity. Think of the load as the difficulty of the given tasks and the capacity as the ability of the tendon to do that task. The more challenging the task, the greater the load through the tendon and if the load well outweighs the capacity, you may start experiencing tendon pain. Our overall aim is the bring the tendon back to a place where there is better balance between these two. We will always aim to increase the capacity and this can be done by strengthening the muscle and increasing the tendons ability to do whatever tasks it struggled to do in the first place. However, sometimes, in order to give the tendon a chance to do this, it may be necessary to slightly reduce the load, for instance modifying training types or intensities.
The type of exercise, or ways that load can be modified, is something for you and your physiotherapist to discuss but this can be a good challenge for you both to commit to and work through together.
Remember, in most situations this isn't strictly a case of damage but more of an imbalance between load and capacity . This results in a tendon that's become upset at being asked to do something it wasn't prepared to do which is probably fair enough!
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