Tendinopathy

Lower limb tendinopathies

We commonly see lower limb tendinopathies in both our Sutherland shire and Helensburgh clinics.

What is a tendinopathy?

A tendinopathy occurs due to a mismatch between the amount of load you are putting through your tendons and that tendons ability to handle the load. This can occur due to a sudden jump in load without giving the tendon enough time to adapt. Such as going for a 3 hour bush walk without preparation, moving from training for a sport to both training and competing without adjusting your training load to account for the increased intensity of competition or maybe you have had a bit of time off sport due to work or another injury and try to get back into it too quickly. When this happens the tendon fibres will become disorganised and their ability to handle a given load will be decreased. We no longer use the term tendinitis as it has been shown that there are no inflammatory markers present in the tendon (though there can still be some inflammation in the surrounding area).

How do I know if I have a tendinopathy?

Lower limb tendinopathies are most commonly found in the Achilles, the front of the knee (Patella), in the side of hip (Gluteus Medius and Minimus) and at the top of the thigh (Proximal hamstring). Our physios will be able to diagnose if you have a tendon issue but typically tendon pain will be worse in the morning and “warm up” with movement. When exercising you may find that the tendon starts out painful, then eases or even goes away completely and is worse again after exercise. You also want to listen to your tendon for 24 hours after exercise. If it flares up during this time this is the tendons way of telling you, you are doing too much.

What can I do about it?

Tendons have a fantastic ability to adapt, but this takes time and patience. Even with a degenerative tendinopathy there is a way forward, as the body will start to form new tendon fibres around the old tendon which we can then train. This new tendon forming is what leads to the lump if you have had your tendon pain for a long time.

The first step is to adjust the load on the tendon. The amount of load your tendon can tolerate is different in everyone and your physio will work with you to find a level of activity that is suitable for your tendon. This can even consist of every day loads such as sleeping and sitting position in the case of a lateral hip tendinopathy.

If you participate in explosive sports and activities that involve running and jumping, it is important your rehab doesn’t just stop when your pain eases. We need to restore the springiness and robustness in the tendon for these activities through heavy resistance training and plyometrics.

By Physiotherapist Jono McLennan