Tendon Pain Treatment
Tendons are very important structures that provide the link between a muscle and its attachment to the bone. In this way, forces exerted by muscles during loading and contraction are transmitted to tendons in order to control movement of joints. Tendons are usually incredibly strong structures that can withstand huge forces.
However, they can become susceptible to pain when they become unhealthy and / or they are exposed to sudden increases in load.
Tendon pain may be labelled as tendinopathy, tendinitis, tendon degeneration or a tendon tear. Tendon pain usually occurs when the tendon and the tissue surrounding it becomes inflamed and sensitive to load. Sometimes the tendon can become swollen and thickened and very tender to touch.
Is tendon pain common?
Tendon pain can affect the young and the old, with up to 30% of the population developing tendon pain at some point in their lifetime.
Tendon pain can be incredibly intense, functionally limiting and distressing – as it results in pain with any contraction of the muscle that is attached to it.
Common tendons that may become painful include:
- Achilles tendon - This tendon provides connection between the calf muscle and the heel bone of the foot.
- Patella tendon - The thigh muscle (quadriceps) exerts force on the patella tendon via its attachment to the knee cap (patella).
- Gluteal tendon - The buttock muscles (gluteals) attach to the thigh bone via the gluteal tendons.
- Hamstring tendons - The hamstring tendons anchor the three hamstring muscles from the sit bone on the pelvis to the back of the shin bones below the knee.
- Rotator cuff tendons - The rotator cuff tendons link the rotator cuff muscles from the shoulder blade to the arm bone.
- Flexor and extensor tendons of the forearm - Commonly known as golfers and tennis elbow. These tendons link the hand and wrist muscles to the bones above the elbow.
Risk factors for tendon pain
Tendon pain usually occurs from a sudden or rapid increase in loading of the tendon, when this exceeds the strength and tolerance of the tendon. This is when you do more than your tendon is capable of, or can recover from in that period of time. This represents the balance between the demands of the movement/activity you want to do, and the capacity of the tendon to withstand that load during the activity.
Common examples include:
- Repeated clenching of the hand during gardening, tennis, golf can result in tennis or golfers elbow.
- Sudden increases in running or jumping resulting in tendon pain in the lower limb – achilles, patella, gluteal tendon.
- Sudden increase in loading of the shoulder due to unaccustomed or repeated over head activities.
The ability of the tendons to tolerate load is impacted by other heath factors. These factors are:
- being overweight
- being sedentary
- smoking
- being stressed
- having low mood
- poor sleep
- hormonal changes associated with menopause
- being run down
- other health conditions such as diabetes
These factors influence the health of the tendon and levels of inflammation in the body, making the tendon less capable to tolerate load and more vulnerable to pain.
Myths about tendon pain and treatment
- Shoulder pain usually means the shoulder is damaged
- Shoulder pain usually means a scan is needed
- If moving the shoulder hurts it means that the movement should be avoided
- Shoulder clicks means there is something wrong
- A rotator cuff tear means surgery is needed
- Shoulder impingement means that using the arm is dangerous and surgery is needed
- A Cortisone injection will fix my shoulder
- Frozen shoulder takes 18 months to 2 years to recover
Facts about tendon pain
- Tendon pain is common without damage to the tendon
- Many people without pain have tendon tears and degeneration
- Scans don’t predict how much pain you feel or how disabled you are
- Scans are usually only needed if you have had a traumatic injury (fall) or hear a snap and suddenly lose power.
- Complete rest is not helpful for tendon pain.
- Stretching and massaging tendons can make tendon pain worse
- Gradually activating the muscle and loading the tendon is the key to rapid recovery and pain relief. In the beginning this cause some pain – however it is not harmful and pain reduces with time.
- Gradually loading tendons makes them stronger and more resilient
- Tendons love heavy and hard progressive loads
- Lifestyle factors such as healthy diet, sleep and physical and psychological health are all important for the treatment of tendon pain
- Injections may offer very short-term relief but a long-term rehabilitation program is the key for tendon pain management
- Even if you have a tendon tear and the pain is chronic you can get better with the right care.
Approaching tendon pain
The first step is to rule out serious injury such as tendon rupture. There is strong evidence that physiotherapy is an effective first line of treatment for tendon pain. If your tendon pain have developed over time, we can help to identify the key factors related to it. Together we build a plan to get you back to full capacity. This is how we go about it:
- We undertake a full history in order to hear your story, how the tendon pain began and how it impacts on all aspects of your life.
- We screen for serious causes of tendon pain.
- We ask you about other aspects of your health.
- We can diagnose the cause of your tendon pain and determine whether you need a scan or not.
- We then perform a comprehensive examination of the tendon and surrounding regions. We look at the postures, movements and activities that you find restricting or painful.
Assessment of tendon pain
This includes an assessment of:
- the sensitivity of the structures to touch, move and load;
- the ability of the tendon to tolerate load
- the way you perform the postures, movements and activities that are painful
- the ability to engage and activate the muscles surrounding the tendon.
- the strength and endurance of the muscles that surround the tendon.
Tendon pain treatment
Body Logic physiotherapists use the above information to explain to you the following:
- where the pain is coming from
- the factors that are contributing to your pain
- develop a plan to reduce tendon pain
- how to best activate muscles around the tendon and increase load tolerance of tendon
- discuss the best treatments options available to you.
This usually involves a graduated program that includes:
- helping you understand the individual factors that are linked to your tendon pain
- helping you understand the demands of the movements and activities you would like to get back to
- this will to determine the capacity of your tendons to tolerate these loads
- learning to activate / engage the muscles that surround the tendon
- an exercise program to gradually increase the load tolerance of the tendon starting with static loading and progressing to dynamic loading
- an exercise program to gradually build the strength of the muscles surrounding the tendon
- an exercise program to get you healthy, fit and active that doesn’t overload the tendon too fast
Other strategies that are helpful to treat tendon pain are
- Improving sleep
- Managing stress
- Healthy eating
- Caring for your mental and physical health
Tendon pain can take 6-12 weeks to recover – and if chronic even longer. The key is to know that if you take a disciplined approach with your rehabilitation program – it will get better over time. The key role for the Physiotherapist is to act as a coach on the journey.
If you are experiencing tendon pain, or for any other condition or service, get in touch with our friendly team today!
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Additional Resources
‘Podcast: Tendinopathy Myth Busting‘ – Professor Jill Cook discusses common tendinopathy myths.
‘Ten Things Not To Do If You Have Lower Limb Tendon Pain‘ – A video summary of Prof Jill Cook’s La Trobe Sport and Exercise Medicine Research Centre blog.
