What actually is a tendon?
Tendons are connective tissues that connect our muscles to our bones. They’re built out of strong collagen fibres that have slight elastic properties to withstand our daily movement requirements. Generally, they are strong and work well.
What can go wrong?
Just like muscles, tendons can undergo continuous micro-tears and repair due to day-to-day activities. Sometimes this happens without us even knowing about it.
If the number of micro-tears start to outpace the repair-ability of the tissue, injuries and pain can start to occur. These may include terms you have probably heard of before like Tendinitis, Tendinopathy, Tendinosis and Repetitive Strain Injuries (RSI).
So, what is a Tendinopathy?
Whilst the terminology is somewhat up for debate in the research, a common umbrella term often used for tendon injury is ‘Tendinopathy’. It’s a bit confusing, but a tendinopathy can then be sub-divided into two terms:
1. a ‘Tendinitis’, which is an acute (short term) tendon injury, and;
2. a ‘Tendinosis’ which is a chronic (longer term) tendon injury.
You may have heard the later referred to as an Overuse or Repetitive Strain Injury (RSI) (1).
How long do acute and chronic tendinopathy’s take to heal?
Tendonitis’ are often associated with an event or moment when an injury occurs. They are often accompanied by large amounts of inflammation and swelling shortly after injury. Typical healing time is approximately 6-10 weeks with appropriate treatment (2).
Tendinosis’ or RSI’s typically come on slowly with no obvious event associated with the pain. Generally, they are not obviously swollen (unless in flare-ups) and can take from 3-6 month to recover, sometimes even longer. The tendon in these cases usually decondition slowly due to repetitive strain, hence the term RSI.
What’s the best treatment?
For a minor tendon injury, the ‘RICE’ protocol is standard practice for many acute tendon injuries and generally works well: REST, ICE, COMPRESSION, ELEVATION.
But for more chronic tendinopathies or RSI’s identification of the cause is key. A skilled clinician can help identify and modify problem activities for faster recovery. It’s largely about promoting the tendon to heal while slowly returning to normal activity or sport.
So, what does the research say?
Conservative treatment of tendinopathies include soft tissue massage, exercise rehabilitation, manipulations, dry needling, mobilisation (3), taping and stretching, but these modalities used in combination with each other have better long-term outcomes.
In more severe cases, corticosteroids injections are also commonly used and can often provide good short-term relief. Interestingly, kinesio-taping, education and exercise strategies have shown to be more effective in the long run, (5) and so too Platelet-rich Plasma (PRP) injections (6).
It’s a complex issue, but there is help!
As always, diagnosis is key when managing a tendon injury, so if you have any doubt’s book an appointment with one of our Chiropractors today on (03) 9772 6307.
References:
(1) Bass, LMT, E., 2012. Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice, 5(1).
(2) Sharma, P. and Maffulli, N., 2005. Tendon Injury and Tendinopathy. The Journal of Bone & Joint Surgery, 87(1), pp.187-202.
(3) Lucado, A., Dale, R., Vincent, J. and Day, J., 2019. Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. Journal of Hand Therapy, 32(2), pp.262-276.e1.
(4) Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H. and Vicenzino, B., 2018. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. British Journal of Sports Medicine, 52(22), pp.1464-1472.
(5) Miccinilli, S., Bravi, M., Morrone, M., Santacaterina, F., Stellato, L., Bressi, F. and Sterzi, S., 2018. A Triple Application of Kinesio Taping Supports Rehabilitation Program for Rotator Cuff Tendinopathy: a Randomized Controlled Trial. Ortopedia Traumatologia Rehabilitacja, 20(6), pp.499-505.
(6) Li, A., Wang, H., Yu, Z., Zhang, G., Feng, S., Liu, L. and Gao, Y., 2019. Platelet-rich plasma vs corticosteroids for elbow epicondylitis. Medicine, 98(51), p.e18358.