Tendons are made of strong connective tissue that attach muscles to bones. Tendon pain typically arises from repetitive overuse and is not restricted to people who do a lot of sports. The more common conditions arising from tendon injury include tennis elbow, plantar fasciitis (heel pain), Achilles tendon pain and rotator cuff injury (shoulder pain). Between 3-5% of the population are thought to suffer from tennis elbow and Achilles tendon pain at some point in their life and are often very difficult to treat once the condition becomes chronic.
Based on current research into the nature of tendon injury, it is more accurate to use the term ‘tendinopathy‘ or ‘tendinosis‘ instead of ‘tendonitis’. Current evidence suggests that tendon pathology does not involve inflammation and is more a ‘failed healing response’. The tendon tissue breaks down and there is an in-growth of new nerves and blood vessels that, unfortunately, appear to be ineffective in healing the tendon and pain. Without treatment, such tendons may become very weak and painful and are at risk of tears.
Tendinopathy typically presents with the following pain pattern:
▪ The pain is usually quite localised to a small area near a joint (i.e. where the tendon is located)
▪ Pain is felt in the morning upon rising, or after a period of resting in a stationary position
▪ The pain improves on warming up, so no pain is felt whilst exercising
▪ Pain returns after exercise
Tendinopathy should be treated as early as possible to prevent further degeneration of the tendon and to prevent the pain from becoming chronic. Osteopathic treatment is directed at addressing excessive muscle tensions that ‘pull’ on the already-strained tendon; and by manually releasing stiff areas in other parts of the body so that the improved overall body alignment will place less strain and load on the involved tendon.
Tendon problems usually take longer to heal than muscle strains and should be managed differently. Apart from osteopathic treatment, specific exercises involving eccentric loading (controlled lengthening of the muscle-tendon against resistance) are also prescribed and carefully monitored.