September 5, 2019 by ACE Physical Therapy and Sports Medicine Institute  
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Tid Bits of Info

  • 50% of all sports injuries occur at the tendon.
  • Tendons are leather-like and transfer force from the muscle to the bones.
  • Tendinopathy involves inflammation and degeneration of the injured tendon tissue.
  • Eccentric contractions of muscles are the best way to treat tendinopathy.
  • Seek the advice and treatment of a Physical Therapist if you have tendinopathy symptoms.

Tendinopathy results in pain, swelling, and even limited movement of the tendon in a specific area like the shoulder, elbow, wrist, hip, knee, or ankle. Recovery can be slow and difficult with the pain and disability lingering for months. Healthcare research indicates a link between tendinopathy and hypersensitivity in the nervous system, which suggests that employing desensitizing techniques should play a role in the rehabilitation.

Tendons are leather-like structures that attach an elastic muscle to the bone.  The role of the tendon is to transfer the force from the muscle tissue to the bone and create movement of a particular joint.  When the force is too great or too repetitive, the tendon tissue can be damaged.  This is referred to as tendinopathy and can be acute or chronic in nature.  When the tendon is injured, initially there is an acute inflammation process that occurs and this causes pain at the site of the injured tendon tissue.  If the repair process does not take place properly, the tissue damage can worsen and the debilitating condition can linger for a prolonged period of time.

There are numerous protocols that are used to help stimulate the healing process of damaged tendon tissue.  These are not always successful and there appears to be more involved with a case of chronic tendinopathy.  Recent research revealed that tendon tissue damage might not be the primary cause of pain in a chronically involved tendinopathy.

Researchers suspected that there might be a more global involvement and their suspicions were supported by the results of their study.  They tested the sensitivity of the nervous system in the area of the injured tissue and the throughout the body.  They found a hypersensitivity to a pain stimulus at the site of the injured tendon.   Interestingly, they found hypersensitivity to the same stimulus on the contralateral hand leading them to hypothesize that the entire nervous system is “over active” when a chronic tendinopathy occurs.  They suggested that part of the protocol for this condition should include “desensitization” of the entire nervous system and at the sight of the injured tissue.

Physical Therapists must incorporate desensitization techniques when they are treating chronic tendinopathy.  Part of the treatment process should include a detailed explanation of pain and what the patient should expect to experience during the rehabilitation process.  Knowledge of the science of pain has been shown to improve treatment outcomes.  In most instances, normal treatment protocols can be initiated and progressed over time.  The patient has to communicate with the Physical Therapist about the amount of pain that they experience during the treatment session and the therapist must modify the routine accordingly.  Being able to “get through” the session without eliciting an intense pain response can begin the desensitization process.

Tendinopathy is a common condition that is routinely treated by healthcare professionals.  When the condition becomes chronic, the damage to the tissue might not be the primary cause of pain.  There is strong evidence that supports the involvement of the patient’s nervous system and its development of hypersensitivity to a painful stimulus. If total resolution of the tendinopathy symptoms is desired it will be wise to have desensitizing techniques employed to help reduce the hypersensitivity throughout the body.


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