Previously, and still, it has been explained that the cause of tendon pain stems from inflammatory conditions in the tendon, so-called tendinitis, but is it really tendonitis?
Tendon pain, both short-term and long-term, can rarely be described as acute inflammatory conditions (1,2). That does not mean that parts of the inflammatory process are not involved. Different cells and signaling substances can play an important role during development and prevent adequate healing of tendon pain. This can also explain some of the pain-relieving effect you get from using NSAIDs and cortisone injections. However, this effect seems to be short-lived.
So it has been seen that there are inflammatory processes to varying degrees around a painful tendon, but that treatment of this inflammation does not seem to be that important for successful rehabilitation (1,2,3).
Read more below for which 3. steps the tendon goes through. 👇🏼
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Is tendon pathology a continuum ?
Tendon problems can go through 3. stages, (4). The first stage is called reactive tendinopathy and involves the tendon trying to adapt to a load to which it is exposed by increasing its thickness without any inflammatory process or changes in the collagen. With adequate adaptation of provoking factors and general stress, the tendon can return to its original state.
The second stage is termed “Tendon Dysrepair” . This is a continuation of the first constant, where the tendon has not calmed down and you can begin to see changes in the tendon’s collagen and matrix and ingrowth of blood vessels and nerves. Here you can often see that the tendon is swollen. Despite these initial changes, they may be partially reversible.
The final stage is called degenerative tendinopathy . Here you see major changes in the tendon’s matrix and collagen composition, and it may seem that the areas of the tendon that have undergone these changes cannot be reversed. But it is uncertain whether this has any major impact on the forecast. This is because it is normal to have changes in the tendon and we find it in people without symptoms as well.
What does this mean for you and me?
Inflammation or not…
For me as a therapist, this is mostly about how we choose to explain tendon pain for the measure that is best. We know that apart from a fully or partially torn tendon, or a very irritated tendon, the best thing we have for tendon pain today is; load .
And then through heavy and calm strength training to make the tendon withstand stress by making the tissue that is good, even better.
So if YOU are going to do what we KNOW is best for your tendon. Would you strain a tendon that you were told was very inflamed? So if it doesn’t seem important whether it’s an inflammation or not for whether you’ll get better, then we should create an understanding of the tendon and load that sets you up as best as possible to succeed!
How do you relate to this?
If you have just had a pain from, for example, Achilles or other tendons, you should take it easy for a few days and do alternative training that does not agitate the tendon further. When it calms down, you should start again as quickly as possible to load the tendon without stirring it. That is that the tendon pain is back to the starting point the following day.
The language the tendon understands is stress! Without load, the tendon loses its properties. So in other words it needs load. This applies especially if you have had tendon pain for a long time.
I tend to say that when the load is the problem, it is also the solution! The only problem is that it can be both the poison, but also the antidote!
Is it actually tendonitis?
As I said, there is a lot of debate around whether it is actually tendonitis. Yes, it seems that the tendon may have traces of inflammatory processes, but it does not seem to be decisive for your recovery and the measure you are going to take, which is to load. It is the best of what we have today.
- BJF Dean, P. Gettings, SG Dakin, and AJ Carr, “Are inflammatory cells increased in painful human tendinopathy? A systematic review
- A systematic review of inflammatory cells and markers in human tendinopathy, 2020
- JD Rees, M. Stride, and A. Scott, “Tendons – time to revisit inflammation, BJSM
- JL Cook and CR Purdam, “Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy,” Bro. J. Sports Med., vol. 43, no. 6, pp. 409–416, 2009.