Tendinopathies

 

Definition - Tendon

A tendon is a strong, fibrous collagen-type tissue  (also referred to as “connective tissue”) that attaches a muscle to a bone.

Definitions - Tendinopathy

Tendinopathy refers to injury of a tendon due to repetitive loading of the tendon.

Symptoms of a tendonopathy  are:

  • pain
  • decreased exercise tolerance of the tendon
  • decreased function

 

Tendon pathology is divided into three stages namely: 

  1. reactive tendinopathy, 
  2. tendon disrepair and 
  3. degenerative tendinopathy.

 

Let’s discuss each phase individually.

1.  Reactive Tendinopathy

Reactive tendinopathy typically involves the tendon responding to a rapid increase in load (for example in runners this means and increases in mileage, less resting days or a change in training type) or as a result of  direct trauma to the tendon. 
In this phase there is no inflammation. 
Reactive tendinopathy usually happens in young active individuals who experience it for the very first time.

The structures in this phase remain intact in other words there is a minimal change in the collagen integrity.

Summary  -
Reactive tendinopathy is a short-term adaptation to overload that thickens the tendon, decrease s its ability to withstand stress and increases the tightness of the tendon. A tendon in the reactive phase has the potential to return to normal if the load is sufficiently reduced or sufficient time of rest between the loading sessions is allowed.

Advice  -
Usually patients may continue with movement that is low in impact.

 2.  Tendon disrepair

Tendon disrepair is a progression of reactive tendinopathy and occurs when the tendon is not offloaded and allowed to heal. 
In this phase there is more cellular breakdown than in the reactive phase.

Tendon disrepair usually happens in the chronically overloaded young athletes.

Summary -
In the phase the tendon is thickened but there is still a possibility to reverse the damage to the tendon with the correct load management and exercises.  

 3.  Degenerative tendinopathy 

In degenerative tendinopathy the changes in the tendon is irreversible as there is even more cellular breakdown than in disrepair phase.

Typically this type of tendon is found in older individuals who struggled for long periods with tendinopathy or younger individuals who have continued with overloading the tendon.

Summary -
The tendon is thickened and can present with palpable nodular sections.