The Do’s and Don’ts of Tendinopathy

Traditionally tendon pain has been given the name Tendinitis. Tendinitis implies that there is an inflammatory reaction to a certain tendon. This diagnosis has recently been argued due to further research; firstly, there is a physical lack of inflammation seen around tendons when a change in exercise or daily habits occur. Secondly, when prescribing patients with Nonsteroidal Anti-inflammatory Medication (NSAIDS) to reduce inflammation, this has seen little improvement with tendon pain. In light of this, the new term ‘Tendinopathy’ was established for medical professionals to use to describe the variety of painful conditions from tendons.

Types of Tendinopathy:

Achilles (ankle) Tendinopathy

Patella (knee) Tendinopathy

Bicep (shoulder) Tendinopathy

Causes of Tendinopathy

The most typical cause of Tendinopathy is a sudden change in exercise habits. During the recent pandemic, we have seen this problem a lot at the clinic as patients have had more time on their hands to start working out again or to try something completely new.

To suddenly start to exercise, such as a long walk or run, will cause a change in tendon load. This creates stress to the tendons and muscles. Another way of stressing tendons, is attempting to pick up your previous level of fitness after having deconditioned over time. Due to the irregularity of working out or the start of a new routine, this will impact on the tendons functionality and strength. Our tendons need time to adapt to new situations and increased or sudden loads.

What you can do for Tendinopathy:

1. Identify what you need to achieve.

2. Look at specific biomechanics of that task. Make sure there are no other body restrictions.

3. Create a progressive loading programme.

4. Stay consistent with it - tendons need daily stimulus to load!

5. Be patient, tendons can be slow to progress.

What you don’t do for Tendinopathy:

1. Don’t neglect your tendon.

2. Don’t rest for days or weeks on end.

3. Don’t rely on orthotics for Achilles Tendinopathy

Blog post by Nick Jordan

Sprained ankle on the tennis court? Think TWICE before grabbing the ICE

If you sprain your ankle on the tennis court, the first port of call is usually the clubhouse freezer. But is ice actually doing you more harm than good?

R.I.C.E. (Rest, Ice, Compression, Elevation) has been the most common initial treatment of acute injury over the last 30 years, as introduced by Dr. Gabe Mirkin in his 1978 publication The Sports Medicine Book. A recent study by the American Journal of Sports Medicine (June 2013), however, has made Dr. Mirkin swallow a slice of frozen humble pie. The study demonstrated no evidence that ice hastened recovery, leading Dr. Mirkin in his 2014 article “Why Ice Delays Recovery” to admit that he was wrong.

So, why is ice not always the best solution?

Firstly, it is worth noting that the inflammatory process is vital for the repair and remodelling of tissues. Common sense would suggest that inhibiting this process may not be the best idea. Ice acts to constrict blood vessels thereby reducing the amount of inflammatory cells deposited by your blood stream.

Although this may reduce pain and pressure on an injury, it also stops healing cells from entering injured tissue. Ice, as well as constricting blood vessels, also constricts the lymphatic system which is responsible for clearing out inflammatory debris. So, you can begin to get a picture of the effect ice has on an injury; less healing cells and a reduced ability to remove inflammatory waste – not ideal for recovery.

So, what should you do?

Here are Dr. Mirkin’s new set of tips for acute injury treatment:

1. Stop exercising immediately; you don’t want to cause further damage.

2. If the injury is very painful, then cold has been shown to reduce pain, in these circumstances you can grab a bag of peas from the freezer but use intermittently – 10 minutes on, 20 minutes off.

3. As soon as possible, get yourself assessed by a health professional to ensure no serious damage has been done.

4. After 48-72 hours the inflammatory process will usually have done its job, movement and the correct exercises then become the order of the day.

5. Joint pumping is a fantastic way of naturally assisting the lymphatic system to remove excess waste, while the correct movements will stimulate tissue repair.

If you are suffering from an injury and need to have it treated, just call the clinic to book an appointment with me.

Neil Sharland
Osteopath M.Ost