Tendon pain and injuries are very common in both the upper and lower limbs. The causes are often multifactoral and can include an acute event, repetitive use, over-training, starting a new activity, increasing the workload and other factors relating to general & tissue health. It is likely that when the pain starts there have already been changes occurring in the tissues and nervous system as the body tries to deal with the problem.
Common sites of pain include the elbow (medial and lateral, golfer’s and tennis elbow respectively), the wrist (e.g./ De Quervain’s), the knee (patellar tendon) and the Achilles tendon. Terms that you may see to describe tendon problems include tendinitis, tendinopathy and tenosynovitis. This can be confusing, however it comes down to which part of the tendon is deemed to be involved by examination (including scans sometimes; MRI, CT or ultrasound) and whether there is inflammation present. Studies have found that the tendon itself is not inflamed, however there can be inflammatory mediators present in the sheath and surrounding tissues. Often signs of degenerating tissue have been found (tendinosis). These findings have implications for treatment choices.
As with any painful condition we know that the actual experience of pain is produced by the brain in response to a perceived threat to the tissues. Where we feel that pain depends upon where the brain deems the threat to exist which is often where the injury lays. This is not always the case and indeed the basis for a chronic problem is frequently a pain with minor tissue changes or without any obvious tissue damage.
We have looked in detail at the research that has been done on tendons and combined this with the latest understanding of pain science to develop a very modern approach to the treatment of tendinopathy.
