Experiencing tendon pain? So was Dr. Alfredson…

In the mid-1990’s, Dr. Hakan Alfredson, an orthopedic surgeon and professor of sports medicine in Sweden, developed a painful Achilles tendon. He asked his boss to operate on the painful Achilles tendon. His boss refused to perform the surgery, citing the fact that it was not severe enough to warrant surgery and that he could not afford to have Dr. Afredson take the time off work for recovery.

Dr. Alfredson was suffering from Achilles Tendinopathy.

What is Tendinopathy?

Tendinopathy, once commonly known by the misnomer tendinitis is an overuse tendon injury that results in pain, decreased exercise tolerance and a reduction in function. Tendinopathy can occur in any tendon in the body, but common sites include the Achilles tendon, Patellar tendon (knee), medial and lateral elbow tendons (i.e. tennis and golfer’s elbow) and the proximal hamstring tendon.

What are the risk factors for Tendinopathy?

There are many factors that contribute to the development of tendinopathy. The main factor is tendon overuse and is associated with a sudden increase in activity that requires a tendon to store and release tensile energy (e.g. walking, running, jumping) and loads that compress the tendon. Other risk factors include sub-optimal biomechanics and altered motor control strategies. Systemic factors such as age, menopause, elevated cholesterol and diabetes may also play a role.

How can physiotherapy help my tendon pain?

Before we dive into this question, let’s return to the rest of Dr. Alfredson’s story!

Frustrated by his boss’ refusal to operate on his tendon, he decided to deliberately aggravate his Achilles tendon by performing a painful exercise program that stressed the Achilles tendon. The goal was to worsen the injury and to rupture it completely, forcing his boss to operate on it. Despite the expected initial worsening of symptoms, over time, the opposite happened! His Achilles Tendinopathy improved!

Our understanding of tendinopathy is now much greater since the 1990’s. We now know that individualized exercise is the most evidence-based treatment for all types of tendinopathy. The hallmark of tendinopathy rehabilitation is load management. Progressive loading of the tendon, while respecting pain, enables the tendon to develop greater tolerance to the load an individual needs to endure in their activities. Therefore, modifying load is important in settling tendon pain, but complete unloading and rest is not recommended, as this does not improve the tolerance of the tendon to load. Correcting biomechanics and movement patterns through exercise is also important.

Are there adjunct Tendinopathy treatments?

Tendon response to exercise is very slow and its rehab requires patience. There are no short cuts and individuals may feel pressured to find a ‘quick fix’. Passive therapy options include shockwave therapy, injection therapies such as cortisone injections (CSI) and platelet-rich plasma injections (PRP), and the prescription of orthotics and/or braces.

The current evidence base suggests that tendinopathy does not improve in the long term with only passive treatments and are best viewed as adjuncts to an exercise based rehabilitation program. Therefore, these modalities should only be considered for individuals who have persistent stable tendon pain.

If you have been experiencing tendon pain, make an appointment to see one of our physiotherapists at SEMI! They are the most qualified practitioners to assess and prescribe the correct loading strategies and exercise progressions for those suffering from tendinopathy. Adjunct treatments are also available at SEMI for the persistently painful tendons that just refuse to get better.