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Tendon related pain is a common condition that affects many
individuals, ranging from athletes to office workers. Tendons are strong fibrous tissues that connect muscle to bones. When exposed to repetitive stress or repetitive loading, tendons can undergo microtrauma, leading to a series of changes within the tendon. These pain presentations often arise due to overuse/overload, repetitive motion or direct injury to the tendons. This can result in conditions such as tendinopathy or tendon tears. The most common tendon related pain presentations seen clinically are; achilles, patella, quadriceps and rotator cuff.
Signs & Symptoms
Pain: typical manifests as localised or pin point pain near the affected tendon. May be sharp, throbbing or aching in nature. Often the pain is worse first thing in the morning.
Swelling and tenderness inflammation of the tendon may cause localised swelling, redness and tenderness. Touching the affected area may elicit pain and discomfort
Stiffness and reduced range of moti
on: tendons that are affected by pain may restrict joint mobility, resulting in stiffness and reduced range of motion. Often activities that require stretching exacerbate these symptoms
Weakness: tendon related pain can lead to muscle weakness or loss of strength in the associated muscle groups. This weakness may impact functional activities and performance
Management:
The following are common evidence-based management strategies that you will be guided through by your physiotherapist:
Rest and activity modification: initially resting the affected tendon is crucial to allow the healing process to begin. Avoiding activities that exacerbate pain or place stress through the tendon (i.e stretching) is essential. Gradual re-introduction of activity and modification of movements may be recommended
Manual therapy: manual therapy techniques such as soft tissue release (deep tissue massage and dry needling) can help reduce muscle tension, reduce pain and improve tendon function
Exercise rehabilitation: progressive exercises focusing on strengthening the calf muscles and lower limb stability are vital for functional recovery. These may include isometric (static loading), eccentric (muscle is lengthening under load) and concentric (muscle is shortening whilst loading) based resistance exercises to develop strength and endurance.
Patient education and injury prevention: providing patients with knowledge about their condition, self care strategies and appropriate pain management techniques. Addressing underlying factors such as muscle imbalances or training load errors are integral.
Pharmacological interventions: in certain situations, non-steroidal anti-inflammatory drugs (NSAIDs) may be beneficial in the initial phase in conjunction with physiotherapy to reduce inflammation. It is important that this is guided by your GP or sports physician.
Imaging: unless there is suspicion of a tendon tear, imaging such as MRI and ultrasound are not usually recommended as first line treatment.
Madison is a qualified physiotherapist who is currently undertaking her postgraduate study in Sports Physio and has extensive experience working in both netball and hockey. Through her work within these sporting environments she has had a vast exposure to tendon related pain which has sparked her a passion for assessing and treating these types of pain presentations. If you have a tendon related pain you would like guidance on, contact the team at PROmotion to start your rehabilitation journey with Madison.
References:
Ackermann, P. W., Alim, M. A., Pejler, G., & Peterson, M. (2023). Tendon pain–what are the mechanisms behind it?. Scandinavian Journal of Pain, 23(1), 14-24.
Cook JL, Rio E, Purdam CR, et al. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?British Journal of Sports Medicine 2016;50:1187-1191