The source of pain in tendons is unknown and there is no centralised sensitisation with a tendinopathy, i.e., it’s not in your head!
Repair of the damaged fibres is not possible, yet the remaining fibres can take over from the damaged ones through a good exercise programme.
12 weeks of an exercise programme that consists of eccentric and isometric exercise with careful loading will improve tendinopathy clinically, but full recovery can take up to a year.
Tendon neuroplastic training is useful (Masci 2023) where the ability to control muscle is practiced therefore restoring the brain-muscle connection. A metronome can be used for this purpose.
MRI has no diagnosing nor prediction value because much of the normal population have asymptomatic degeneration in their tendons.
Compressive and tensile loads lead to the greatest injury.
Tensile force is more relevant than compression with regards to injury.
Intense loading of tendon through exercise or activity causes depletion of the protein matrix up to 36 hours post activity.
Your tendons need a recovery time after exercise and activity where there has been an increased loading.
Pathological tendon has more good tissue but do respect pain.
References
· Breda SJ et al (2021) Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. J Sports Med, Vol 55, 501–509.
· Bullock GS et al (2021) Clinical Prediction Models in Sports Medicine: A Guide for Clinicians and Researchers J Ortho & Sports Physical Therapy, Vol 51, No 10, 517- 526.
· Canosa-Carro L et al (2021) Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) Accessed 28/03/2023.
· Clifford C et al (2020) Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials.
· BMJ Open Sp Ex Med 5:e000760. doi:10.1136/bmjsem-2020-000760 file:///C:/Users/User/Documents/OMTPG/Tendonopathy/Tendinopathy%20article%201.pdf Accessed 28/03/2023.
· Cook J et al (2009) Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy.Br J Sports Med 43:409-416.
· Cook et al (2016) Revisiting the continuum model of tendon pathology: what is its merit in clinical practice. Br J Sports Med 50:1187-1191.
· Cook J et al (2019) Managing Difficult In -Season Tendinopathies. Aspetar Sports Medicine and Science in Athletes Targeted Topic pg. 268-271 www.aspetar.com/journal Accessed 28/03/2023.
· De Vos et al (2021) Dutch multidiscipline guideline on Achilles tendinopathy Br J Sports Med 55,1125-1134 https://bjsm.bmj.com/content/55/20/ accessed 24/06/2023.
· Hanlon S L et al (2021) Beyond the Diagnosis: Using Patient Characteristics and Domains of Tendon Health to Identify Latent Subgroups of Achilles Tendinopathy J Ortho & Sports Physical Therapy, Vol 51, No 9, 440-448.
· Jones LE et al (2014) The Pain and Movement Reasoning Model: Introduction to a simple tool for integrated pain assessment Manual Therapy Vol 19, Issue 3, Pages 270-276.
· Magnusson SP et al (2019) The impact of loading, unloading, ageing and injury on the human tendon J Physiol 597.5, 1283-1298.
· Masci L (2023) Tendon Neuroplastic Training: More effective rehab for tendonitis https://sportdoctorlondon.com/tendon-neuroplastic-training-more-effective-rehab-for-tendonitis/ Accessed 22/04/23.
· 14.Masci L (2020) How to treat tendonitis from a tendonitis specialist https://sportdoctorlondon.com/tendonitis-specialist/ Accessed 22/04/23.