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Tendonitis Physiotherapy & Hand Therapy

Tendonitis, tendinopathy and tendinosis are actually all tendon injuries and unfortunately, they can happen at ANY tendons of the body.

Yes, that's true.

That being said, generally, tendon injuries happen in 3 areas:

  1. musculotendinous junction (where the tendon joins the muscle)
  2. mid-tendon (non-insertional tendinopathy; usually due to cumulative micro-trauma from repetitive stress/over training)
  3. tendon insertion (e.g. into bone)

What is a Tendon Injury?

Tendons are super-tough fibres that connects our muscles to bones.

Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle.

A tendon injury may seem to happen suddenly, but usually it is the result of repetitive tendon overloading. There are a few different names out there but the most common are tendinitis (or tendonitis): This actually means “inflammation of the tendon,” but inflammation is actually only a very rare cause of tendon pain.

The most common form of tendon injury is tendinosis.

Tendinosis refers to a noninflammatory degenerative condition that is characterized by collagen degeneration in the tendon due to repetitive overloading.

That's why these types of tendon injuries generally do not respond well to anti-inflammatory treatments and are best treated with physiotherapy and hand therapy

first of all, What Causes a Tendon Injury?

Frankly, most tendon injuries are really caused by gradual wear and tear to the tendon.

Anyone who uses their body to make the same movements over and over in their jobs, sports, occupations and daily activities are at risk of injuring their tendons and having tendon pains.

Yeah, though tendons are really tough stuff, made to withstand high and repetitive loads...sometimes the load or the duration of the load is greater than the tendon's ability to

  • take and/or
  • regenerate

And then the tendon starts to get damaged and painful.

It starts with micro-tears along the tendons, which causes swelling to happen but at this stage, it can be quickly managed with good physiotherapy and hand therapy care.

However, if the load isn't reduced and continues to be loaded onto the tendon, these micro-tears can become worse and worse, causing more pain and tendon dysfunction, leading to tendinopathy or tendinosis.

Researchers are saying that tendinopathies are associated with high tendon tension and compression forces during activities or sports.

For example, in explosive jumping movements, forces delivered to the patellar tendon can be eight times your body weight. Cumulative microtrauma appears to exceed the tendon’s capacity to heal and remodel.

What are the Symptoms of Tendinosis?

Tendinosis usually causes pain, stiffness, and loss of strength in the affected area.

  • The pain may get worse when you use the muscle, joint and structure that's associated with the injured tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice crepitus (crunchy sound or feeling) when you use the tendon.

Tendinosis Phases

The inability of your tendon to adapt to the load quickly enough causes tendon to progress through four phases of tendon injury.

While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinosis

  • Normal tissue adaptation phase
  • Prognosis: Excellent.
  • Normal recovery expected

2. Tendon Dysrepair

  • Injury rate > Tendon repair rate
  • Prognosis: Good (Tissue is attempting to heal and recover)
  • It is vital that you prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinosis

  • Cell death occurs
  • Poor Prognosis – Tendon cells cant catch up with healing or repair

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis: very poor.
  • Surgery is often the only option at this late stage tendon pain and injury

It is very important to have your tendinosis professionally assessed to identify it’s injury phase. Identifying your tendinosis phase is also vital to direct your most effective treatment, since certain modalities or exercises should only be applied or undertaken in specific tendon healing phases.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, our physiotherapist and/or hand therapists will ask questions about your past health, your symptoms and exercise regime.

We will then do a physical examination to confirm the diagnosis.

If your symptoms are severe or you do not improve with early treatment, we will refer you to a specialist such as an orthopedic surgeon to undergo specific diagnostic tests, such as an ultrasound scan or MRI.

physiotherapy and hand therapy for tendon pains and tendonitis

It may take weeks or months for a tendon injury to heal.

It's annoying at times, but please be patient, and stick with your physiotherapy / hand therapy treatment.

If you start using the injured tendon too soon, it can lead to more damage.

Physiotherapy and management may include:

Patients may benefit from regular core strengthening exercises including clinical Pilates as well as acupuncture therapy for pain management.