A doctor will help treat a man's tendinopathy.

Photo: SuperOhMo (Shutterstock)

Most of us have heard the term “tendonitis” usually when it comes to conditions like tennis elbow, swimmer’s shoulder, or one of the many other overuse injuries we can develop. When we develop an overload injury, our instinct for recovery is usually calm and ice. However, as we now realize, resistance training is the best treatment. This is because most of what we casually refer to as tendonitis is more accurately described as tendinopathy. The difference is not just a matter of semantics; It is also a question of which treatments are most effective.

There has been a paradigm shift in what we know about the cause of tendon pain and the best way to treat it in the past 10-15 years. Given how recently this shift occurred, there is still a lot of confusion surrounding the terminology and what is really happening to your tendon.

“As a medical community, we’ve really shifted the scope of what we think is going on, which has resulted in a naming convention change that is confusing to everyone,” said Jennifer Zellers, a faculty member at Washington University in St. Louis, whose research focuses on tendons. Given how young this shift was, the term tendonitis is still used in relation to overuse injuries, but this is no longer correct.

What causes tendon pain?

Real tendinitis, i.e. tendinitis, is less common than previously thought. In contrast, tendinopathy is a general term that refers to pain in the tendon. In addition to tendinitis, this also includes other causes, including degeneration of the tendon.

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In recent years, scientists have found out that this pain can be traced back to an incipient degeneration of the tendon in the case of overuse injuries such as tennis elbow or swimmer’s shoulder. With tendon degeneration, a tendon develops small tears or the collagen fibers become disorganized. With appropriate treatment, the tendon has a limited ability to heal.

“There isn’t a really strong inflammatory response in the tendon,” Zellers said. “What happens is more of a tendon degeneration. The feathery proteins that make up the tendon become quite disorganized, along with some other changes in tendon composition. But it is not flammable. ”

Treatment options for tendon pain

The discovery that tendon pain is often due to degeneration rather than inflammation has shifted treatment options. Previously, the prescribed treatment for overuse injuries was rest and the use of anti-inflammatory drugs such as ibuprofen. While this will reduce the pain, it doesn’t really address the cause of what is going on.

“One of the treatments with the best evidence is gradually increasing the load on a tendon,” Zellers said. “It’s much more about changing a person’s activity than completely resting, and it’s much more about putting ever higher loads on the tendon, but in such a way that the tendon can adapt and respond and prepare for higher loads is.”

This treatment is often under the guidance of a physical therapist, who can provide advice on exercise, number of repetitions, and weight. As Zellers notes, however, progressive tendon loading can be achieved without the use of special equipment. Instead, one person would need weights the most.

“If someone is really comfortable with self-management and self-progress, this should be something that someone can manage on their own without having to go to a physiotherapist for long,” said Zeller.