What Is Tendinopathy?
Tendons are components of the locomotor system connecting muscles to bones. They transmit forces generated by muscles. Inflammation is the body’s healing response — blood vessels at the site of damage dilate, allowing nutrients and proteins to reach the area, significantly accelerating regeneration. Tendinopathy refers to conditions in which the body’s regenerative capacity cannot keep pace with the damage occurring in the tendons, leading to acute or chronic inflammatory states.
Which Tendons Are Affected?
Tendinopathy occurs in tendons subjected to the greatest loads. In the lower limb, these are the Achilles tendon (connecting the heel to the triceps surae muscle) and the patellar ligament (connecting the patella to the tibia — “jumper’s knee”).
In the upper limb, tendinopathy affects the rotator cuff tendons, the biceps brachii tendon, wrist extensors (tennis elbow) or wrist flexors (golfer’s elbow). These names are popular — the problem can affect people who have never played tennis or golf.
Causes of Tendinopathy
Tendinopathies result from mechanical injuries — either a single strong injury or, more often, repeated small damages in the same location. Predisposing factors include:
- Inappropriate footwear
- Posture defects
- Muscle imbalance
- Running on uneven surfaces
- Lack of appropriate preparation for training
- Sudden change of training or sport
- Inadequate recovery
- Inability to activate deep muscles
- Incorrect movement mechanics
- Systemic diseases: diabetes, gout, hyperthyroidism, rheumatoid arthritis
- Dehydration
Symptoms of Tendinopathy
Typical signs of inflammation: pain, redness, swelling and warmth. Inflammatory pain typically increases during rest (e.g. at night) and eases after warming up — which can lead to further damage, as the person assumes the pain is gone and continues the same activity.
There is a popular myth about Achilles tendinopathy and patellar tendinopathy (jumper’s knee) — that you should “run through” the pain. This is wrong.
Diagnosis
Appropriate history-taking and manual assessment can almost certainly confirm tendinopathy. For athletes, larger injuries or uncertainty, ultrasound imaging is the investigation of choice — it precisely identifies the level of damage and prognosis. X-ray is unnecessary as tendons are not visible on it.
Rehabilitation of Tendinopathy
The process must be carried out carefully and with the patient’s full awareness, as they take a conscious part in the healing process. First, reduce loads causing symptoms — decrease frequency or temporarily stop the activity provoking damage.
The key is subjecting the tendon to loads that don’t provoke symptoms, which should be progressively increased over time. This stimulus supports the rebuilding of collagen structure in the tendon. Stopping movement halts regeneration.
Manual therapy of soft tissues and joints plays an important role — it improves tissue quality, facilitating gliding and nutrition. Kinesiology taping is an excellent complement. Adjunctive physiotherapy modalities include electric current, light, magnetism, ultrasound and low temperature. Shockwave therapy has proven analgesic effect in tendinopathy.
Treatment
Supplementation with minerals, vitamin C and collagen-containing supplements complements rehabilitation. If damage has become chronic, minimally invasive methods may prove insufficient — platelet-rich plasma (PRP) injected directly into the damaged site may then help.
Non-steroidal anti-inflammatory drugs (NSAIDs) are easily accessible but only mask the problem — they don’t accelerate regeneration. Removing pain means you may unknowingly worsen your condition. Consult a physiotherapist or orthopaedic specialist as early as possible.
Originator, founder and mentor of Personal Training Center FitMixer
Sandra Szychowska is a certified personal trainer and physiotherapist at FitMixer, speaking Polish, English and German (PL/EN/DE).
Licensed Strenght Conditioning Trainer, a graduate of the Academy of Physical Education in Krakow at
