Rehabilitation of a tendinopathy

How do tendons adapt to loading?

When we contract a muscle connected to a tendon with enough force, the tendon will stretch slightly. The cells within the tendon can sense this force, and respond by making more proteins to make the tendon stronger. By making the tendon stronger, we are improving its ability to tolerate training including running, jumping, and kicking.

  • Loading the tendon with exercise improves collagen cross links = greater tendon stiffness = Improved ability to tolerate training

Figure 1A: Tendinopathy and tendonitis - Physio Frenchs Forest, Physio Macquarie Park

Why is rest not recommended?

The tendon will only alter its structure when loaded correctly and with the optimal load (goldilocks zone). Rest may reduce day to say symptoms, however when the tendon exceeds its capabilities it will result in pain.

  • This causes a continuous cycle of:

    Rest -> overload with exercises -> pain -> Rest (again).

 

How long until you are better?

As a tissue, tendons are not very metabolically active when compared to muscles. They therefore take longer to strengthen in response to an exercise program. Acutely, painful tendons can settle within weeks, whereas chronic tendons can take 3-12 months to improve.

 


Set in Motion Physiotherapy Frenchs Forest and Macquarie Park: Tendon Rehabilitation Process.

The Tendon Rehabilitation process:

Stage 1: Reactive Stage: Identify the tendon type and calm down the tendon

Reactive Tendons: This includes young adults, acutly over-loaded tendons, and patients with no prior history

Degenerative or reactive on degenerative: Includes patients with a small but noticeable increase in load and middle age and older adults

 Rehabilitation plan:

  • No stretching at this point

  • Cease aggravating activity

  • Isometric exercises (prescribed by the physio)

 

Stage 2: Loading Stage: Strengthening the Tendon

  • Slow, heavy resistance exercise prescribed at 8 reps, 4 sets at 70% Max 1RM


Stage 3: Power development and increase the stretch shortening cycle

  • Exercises in this stage are aimed at developing power in the tendon and improving its ability to absorb load.

 

Stage 4: Sports Specific Requirements

  • This stage is aimed at reproducing sport specific movements and load the tendon in a lengthening position to ensure the athlete returns to full function.


One of the failures of a tendon rehabilitation program is not progressing through each of these stages of rehab. If a rehabilitation sage is progressed too early, the process will not work. Conversely, if the program is not progressed beyond stage 2, it will also not work.


See our expert Physiotherapy team at Frenchs Forest and Macquarie Park!

Reece Jonespatella tendinopathy, achilles tendinopathy, tendonitis, glute med tendinopathy, physio frenchs forest, physio macquarie park, physiotherapy frenchs forest, physiotherapy macquarie park, achilles, tendinopathy, physio running