Symptoms:

  • Pain in the area of the tendon
  • reduced load capacity
  • thereby restrictions in sports and later also in everyday life
  • Patellar tendinitis / Jumpers knee
  • Tennis elbow
  • Achilles tendonitis in the area of the rotator cuff (lmpingement)

But is it really inflammation?

Even if the symptoms are similar to those of an inflammation, this is not a pure classic inflammation, especially if the symptoms persist! Just sparing and waiting is unfortunately not the solution!

But what happens to the tendon then?

  • the tendon is “stressed” (acute overload)
  • the cells of the tendon (= tenocytes) produce more proteoglycans (proteoglycans bind water in various tissues in the body)
  • these bind more water in the tendon
  • this leads to a thickening of the tendon (the tendon appears swollen)
  • this partially destroys the collagenous fibers of the tendon
  • this leads to repair processes in the tendon -> a vicious circle?

Parkinson, J., Samiric, T., llic, M. Z., Cook, J., & Handley, C. J. (2011). lnvolvement of proteoglycans in tendinopathy. Journal of musculoskeletal & neuronal interactions, 11(2), 86-93.

What are the triggers?

  • Overload (very long training sessions, too few breaks between training sessions, unaccustomed extra workload)

in combination with:

  • Age
  • Gender
  • Genetics

What causes it not to get better?

  • Further overload/ poor stress management
  • Only sparing

Possible classification:

One can roughly distinguish between. reactive and degenerative tendopathy. Tendopathy is also the correct term here (chronic tendonitis is rather misleading).

Example:

reactive tendopathy: young athlete, overload during training
degenerative: older person, thickened tendon with “nodules” (e.g. Achilles tendon)

What can you do now? Training recommendations?

Reactive tendopathy:

  • Load management: analysis and adaptation of training sessions in terms of training type, intensity, duration and frequency (e.g. more rest days between intensive training sessions, 3 days are recommended for tendon regeneration)
  • It is mainly about the adaptation, if necessary temporary reduction, of intensive loads such as jumps, sprints/loads that trigger the pain.
  • Strength training, cycling rarely pose a problem

Degenerative tendopathy:

  • Intensive strength training (gradual, low-pain build-up, e.g. in the case of Achilles tendon tendopathy: calf raises, among other things, up to 6 Rm)
  • helps to return to normal the processes in the tendon

Cardoso, T. B., Pizzari, T., Kinsella, R., Hope, D., & Cook, J. L. (2019). Current trends in tendinopathy management. Best practice & research. Clinical rheumatology, 33(1), 122- 140. https://doi.org/10.1016/j.berh.2019.02.001

Cook, J. L., & Purdam, C. R. (2009). ls tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine, 43(6), 409- 416. https://doi.org/10.1136/bjsm.2008.051193

And what else?

  • Training should be the basis of therapy
  • it can have an analgesic effect and also changes the tendon structurally
  • Supportive, other pain relief measures can be used if necessary (e.g., medications: NSAIDs)
  • Stretching can even be rather counterproductive (increased compression of the tendon)
  • Friction massages can provoke the pain and do not lead to any functional improvement

Cardoso, T. B., Pizzari, T., Kinsella, R., Hope, D., & Cook, J. L. (2019). Current trends in tendinopathy management. Best practice & research. Clinical rheumatology, 33(1), 122-140. https://doi.org/10.1016/j.berh.2019.02.001

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