A tendon connects muscle to bone. A tendon is cordlike in structure formed by dense fibrous connective tissue composed by many collagen fibres (fibrin threads) packed tightly together with some elastin fibres - embedded in a extra cellular matrix. These fibres make the tendon very strong by providing its tensile strength so that the tendon can withstand strong pulling forces.
Acute tendon pain injury
This can either refer to a complete rupture or partial rupture tendon injury causing pain, swelling and loss of motion depending on severity of incident following injury. This type of injury is very common in tendons that have to perform greater functional loads such as the Achilles' tendon and patella tendon.
Chronic tendon pain injury
This injury has so many terminologies however it is generally accepted as a tendinopathy injury. Often associated by a number of influences e.g. - volume of intensity of tendon loading, body mass, age, gender, amongst others. Improper loading of the tendon may cause the tendon to heal inadequately which may cause ongoing minor damage and swelling to the tendon tissues. This increased swelling (vascularisation) has been reported to be one of the main reasons why we may experience pain whilst suffering from a tendinopathy injury.
Although tendons are highly adaptable to withstand loads the healing process is much more complex than skeletal muscle. Typically tendinopathies injuries are classed in 3 stages although ideally classed as a continuum
A reactive phase
The collagen fibres stay intact despite being overloaded in response to greater increases in load or as a result from trauma. This has been described as a thickening of the tendon due to overload to reduce the stress by increasing stiffness of the tendon. Possible causes, rapidly increasing training loads such as mileage, inadequate rest between training sessions or sudden changes of training exercises.
Tendon - dysrepair stage
Very similar to the 'Reactive Phase' but with increased breakdown in the collagen matrix which may have a higher degree of vascularity and neuronal in-growth. Likely causes the tendon continues to be overloaded with lifestyle activity.
Degenerative tendinopathy stage
The tendon breaks down and becomes less efficient due to multiple changes and disorganisation in composition. This can lead to degeneration of the tendon as well as increasing the likelihood of a tendon rupture. This is characterised by advanced thickening and neuronal in-growth of the tendon due to persistent over-load.
Tendinopathies are complex structures. Successful rehabilitation requires sound clinical reasoning to help identify the correct stage to conduct the rehabilitation process. If left untreated the condition may get worse. Depending on clinical assessment findings, Nick will help you by offering advice on how to best manage the problem to help ease your symptoms including treatment supplemented by exercise.
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Magnusson, SP. Langberg, H. Kmart, M. (2010) The Pathogenesis of Tendinopathy, balancing the response to loading. Nat Rev Rheumatol 6(5)262-8
Cook, JL. Purdam, CR (2009) Is Tendon Pathology a Continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Medicine 43(6)409-16