What is a Tendinopathy And How To Treat It? 

When treating tendinopathies, it’s important to take action as soon as you start to feel pain or discomfort. The longer you wait to treat it, the worse it gets and the longer it will take to recover. See your health care provider to evaluate if you believe you have tendinopathy.
Tendon injuries can also vary in severity. Grade 1 is mild, there is pain but little damage to the tissue. This is likely to be your tendinopathy.  Grade 2 is moderate, there is a partial tear of the tendon that could be visible on imaging but the muscle still can heal on its own over time. There may be some swelling, bruising and loss of function. You will have pain bearing weight on the limb. Finally grade 3 is a severe tear, partial or full tear of the tendon. There is little to no stability, you lose all function of that muscle and there will be a lot of swelling and bruising present.  If grade 3, there is a chance you may need surgery. Grade 3 strains to a tendon are less common in running as grade 3 is more acute in nature. Meaning a severe and sudden onset of the injury opposed to chronic strains or tendinopathies that both occur with a longer more steady onset. 

If diagnosed with tendinopathy, here are some signs that you would experience. 

Signs of tendinopathies

• Pain starting exercise that gets better as you warm up. 

• Pain stretching a muscle 

• Pain contracting a muscle 

• Pain with touching that spot on the body 

Treating a tendinopathy looks the same no matter what part of the body it is in ( calf, quad, hamstring, back, arm etc). You will need rest, this can be anywhere between 1 week to 6 weeks. This does not mean you can’t do anything for 6 weeks. Your Physical therapist or athletic trainer may put you in a walking boot or crutches short term to get the tendon to calm down. They may have you cross training on a bike or swimming to avoid the strain that running has from all the impact. And they may have you starting up exercises right away to strengthen the tendon as soon as possible.

Some exercises may be light stretching, eccentrics, balance, foam rolling and functional rehab. 

1. Light stretching can be good to get a muscle warmed up and relieve some pain but doing a lot of end range stretches can cause further damage. You want the tendon to heal, over stretching it will be delaying the healing process. Try keeping the muscle in a mid range position, you should feel only slight discomfort, for about 40-60 seconds 4-6 times. This is a static stretch, not active or ballistic. Click here to read the difference between these types of stretches. 

2. Strengthening / Eccentrics
   Eccentrics are the best exercises for tendons as they make you stronger in the lengthened position. You are most likely to injure a tendon or a muscle when it is in its most lengthened position and something unpredictable happens to it. By working the muscle eccentrically, the tendon can get stronger and stretch as well. This helps build back thickness and length of the tendon by increasing the number of cells in the tendon.Some examples of eccentric exercises are. Heavier loads are needed to improve the muscles capacity of lifting but making them too heavy will cause compression on the tendon and delay the healing. 

Negative calf Raise 

• Standing on your toes on a step, have your heels hang off. Go up on both feet and then slowly lower yourself down below the step into a stretching position. Try to count for 6 seconds to go from the top to the lowest point. 

Hamstring walkouts

• In a bridge position, lying on your back, feet on the ground, knees bent to 90 degrees, lift your hips up off the ground by pushing your feet into the ground. Your back, hips and knees should all be flat. In this position walk your feet farther away from your body. As you take each step the hamstring muscle will be lengthening and the exercise will become harder. 

Reverse Nordic

• Kneeling down on a pillow or soft foam mat, tuck your toes under so your weight is pushing through your toes and knees. Keeping your core muscles engaged, bend at the knees as you move your body backwards. You will feel this in your quads as they lengthen. Try to do this slowly counting for 6 seconds from starting to ending position.  When you can’t get any farther, come back to the starting position. 

3. Stabilizing the joints is also important to treat tendinopathies because balance and supporting the joints is necessary to prevent further injury and can’t be done without the support of the tendons. Some of these exercises may be, single leg balance, Single leg Romanian deadlifts, single leg glute bridges, etc.  

4. Once the athlete can develop strength in the exercises given, functional training, doing them more specific to your sport, is warranted. Have a health care provider observe you running and/or doing your sport so they can note any weaknesses or deformities that could have contributed. 

Sources 

“Tendinopathy Rehabilitation.” Physiopedia, www.physio-pedia.com/Tendinopathy_Rehabilitation. Accessed 9 Jan. 2024.

Cleveland Clinic medical professional. (n.d.). Tendinopathy: Symptoms, Causes & Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22289-tendinopathy 

Tendinitis and Other Chronic Tendinopathies : JAAOS - Journal of the American Academy of Orthopaedic Surgeons. (n.d.). LWW. https://journals.lww.com/jaaos/abstract/1998/05000/tendinitis_and_other_chronic_tendinopathies.3.aspx