3 Types of Tendinopathies: Tendonitis, Chronic Tendinopathy and Tenosynovitis
Tendinopathies are conditions that affect the tendons, the flexible bands of connective tissue that attach muscles to bones. The three main types of tendinopathy are reactive tendinopathies, also commonly known as tendonitis; chronic tendinopathy; and tenosynovitis. While all three affect the same area of the body, they have their own distinctions and should be treated accordingly.
What are tendons?
Tendons are bands of connective tissue that attach muscles to the bones and help them move. The tendon itself does not contract in the way that muscle does, rather it just transfers the force that the muscle is producing through to the bone. This is how muscles are able to move bones; through their connection with tendons.
The large tendons in the body that are well known are the Achilles tendon, which connects the calf muscles to the heel, and the patellar tendon, which connects the thigh muscle to the kneecap.
How do tendons work?
Tendons are made up of tendon fibers and tendon cells. The tendon fibers are the main component that gives tendon its strength. These tendon fibers are put together like a rope, with the tendon cells acting as a glue to hold them all together.
The most important thing that we need to understand about tendons, from a functional standpoint, is that they have the ability to store load within them. This means that the tendon itself can absorb some of the force that is being generated by the muscle and help in storing this energy until it is needed.
The best example of this is jumping, where the tendon is storing the energy generated by our muscles and then releasing it. Think of the tendons in this case as a rubber band, being stretched as we hit the ground and then being released as we jump. This allows us to jump higher than we would be able to do without tendon’s help.
How do tendons stay healthy?
Tendons are load dependent organs. This means that for them to stay healthy, they need to be loaded regularly. Regular loading of the tendon helps keep it strong and flexible. Additionally, tendon health can be improved with proper nutrition and adequate rest.
How does a tendinopathy (a grumpy tendon) occur?
Tendinopathies, or tendon diseases, can occur when the tendon is over-loaded. This can happen for a variety of reasons such as repetitive strain, poor posture and lack of exercise.
There are 2 main reasons why an overload occurs:
1) A recent increase in load. For example someone who has just started getting into a running program. They were doing little to no running 6 weeks ago and now they are running 3x 5km per week. From a tendon perspective, this may be too much too soon for the tendon to handle.
2) People who are fit and active who have time off and then attempt to return to their normal activity loads. This is quite common in people who go on holiday or have a bout of illness that prevents them from training. When they recommence training the tendon undergoes a local increase in load in a very short period of time.
What are the symptoms of tendinopathies?
The most common symptoms of tendon disease are pain, tenderness and loss of flexibility in the tendon. Pain can often be felt during normal activities such as walking or running for tendons in the legs or doing simple activities such as hanging out the washing for tendons in the elbow or shoulder. Pain can definitely still persist at rest. Tenderness may be present with gentle touching of the tendon and swelling may also appear around it.
I though there was only tendonitis, what are these other types of tendinopathy?
Reactive tendonitis, or tendonitis for short, is an acute tendon disorder caused by overuse of the tendon in question. Symptoms usually appear quickly, with pain that can range from mild to severe. This type of tendon inflammation often responds well to rest in the short term and should not be ignored.
Chronic tendinopathy (also known as Tendinosis) is a more long-term tendon disorder that typically appears as a result of repetitive strain from activities such as running, jumping, and weightlifting. It usually manifests itself as pain that increases with movement but doesn’t necessarily cause inflammation or swelling. Tendinosis causes the tendon to become weak and painful, leading to decreased strength. In athletes this appears as a decrease in performance, in us mere mortals it may be the difference between and enjoyable holiday and a nightmare. Treatment for chronic tendinopathy requires more intervention than reactive tendonitis, including tendon loading exercises prescribed by a physiotherapist. The timeframes that we are looking at for treatment tend to be measured in months as opposed to weeks.
Tenosynovitis is tendon inflammation caused by a tendon sheath becoming inflamed. A tendon sheath is like a protective coating around the tendon, helping to keep it lubricated and reduce friction. When this tendon sheath becomes inflamed, it can cause pain due to reduced range of motion in the joint as well as causing weakening of the tendon fibers themselves. Treatment for tendon sheath inflammation usually involves anti-inflammatory medication, rest and light tendon loading exercises in the short term, before a more rigorous regime is implemented.
How do they get better?
Great question! We detail that in our next blog on “How do Tendons get better?”