Overuse injuries can be difficult to manage particularly chronic tendinopathies. Tendons most commonly affected include the achilles, patella, elbow and hamstrings. The transmission of force from muscle to bone which results in joint movement is provided by the tendon.
Tendonitis literally means inflammation of the tendon. This is probably a bad way of describing ongoing chronic tendon pain. Inflammation of the tendon does occur but the most common tendon disorders involve degeneration of the tendon. The tendon is often devoid of inflammatory cells. Tendons are predominately made up of collagen fibres. It is the breakdown of the normally organised collagen bundle that results in failure to cope with the load or the pain one experiences during or following activities.
The key to tendon repair is to change the collagen. The only way to change collagen is to exercise. Eccentric exercise (lengthening of the muscle) has been proven, through research, to repair and regenerate collagen. The eccentric exercise increases the loading through the tendon and this encourages collagen synthesis and healing. Treatment of tendinopathy involves a multimodal approach including activity modification, appropriate exercises and biomechanical correction.
New innovations on the medical side include the use of aprotinin injections which inhibit the enzymes that cause collagen breakdown. Your physiotherapist is able to prescribe a clear and detailed exercise programme. This will include appropriate education, guidelines and expectations which are the key to a successful outcome.
