27 Tendinopathy

Rehabilitation for Tendon Pain

Tendinopathy is the preferred term for persistent tendon pain and loss of function related to mechanical loading (Scott et al., 2020).

  • Patellar tendinopathy is the preferred term for persistent patellar tendon pain and loss of function related to mechanical loading.
  • Achilles tendinopathy is the preferred term for persistent Achilles tendon pain and loss of function related to mechanical loading.
  • Peroneal (fibularis) tendinopathy is the preferred term for persistent peroneal (fibularis) tendon pain and loss of function related to mechanical loading.
  • Persistent tendon pain and loss of function related to mechanical loading of the medial or lateral elbow tendons should be referred to as medial or lateral elbow tendinopathy.

Pathophysiology

The presentation of pain in a tendon, does not always mean that the tendon is the primary contributor to pain. The multifactorial model of tendinopathy suggests that an impaired motor system, local tendon pathology, and changes in the pain/nociceptive system contributes to the complex clinical picture of tendon pain.

Examination

A thorough health history intake can be done to gather information about patients’ limitations, course of pain, and prognostic factors for delayed recovery (e.g., low self-efficacy, fear of movement, ineffective coping strategies, fear-avoidance, pain catastrophizing) and answers to health-related questions. Screen patients to identify those with a higher likelihood of serious pathology/red flag conditions. Then undertake a physical examination: neurological screening test, assess mobility and/or muscle strength.

Incorporate one or more of the following outcome measurements when assessing and monitoring patient progress:

  • Self-Rated Recovery Question
  • Patient Specific Functional Scale
  • Brief Pain Inventory (BPI)
  • Visual Analog Scale (VAS)

Treatment

Education

Provide reassurance and patient education on condition and management options and encourage the use of active approaches (lifestyle, physical activity) to help manage symptoms.

Manual Therapy

A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. There may be times that focal irritability (i.e., nerve irritation, trigger points, nervous system sensitization) co-exists with tendon pain. Gently stretching the muscles, neurovascular structures, and investing fascia activates endogenous pain modulating systems that help to modulate neuro-immune responses. 

Self-Management Strategies

Massage therapists not only provide hands-on treatment they can also develop self-management programs to help patients manage symptoms. Simple home-care recommendations such as hydrotherapy, relative rest, and strengthening exercises may be useful for people with tendon pain.


Tendinitis, Tendinosis, Tendinopathy? Exercise is the best medicine for tendon pain.


Prognosis

Multimodality options self-care techniques such as exercise therapy, relative rest, activity modifications should be considered as the first line treatment of tendon pain (Irby et al., 2020). Clinicians managing tendon pain should be thoughtful and skilled in managing the load on the tendons and supporting structures through a number of rehabilitation considerations including, but are not limited to manual therapy, education on psychosocial factors such as fear avoidance, and remedial loading programs.

Key Takeaways

Contemporary multimodal massage therapists are uniquely suited to incorporate a number of rehabilitation strategies for tendon pain based on patient-specific assessment findings including, but not limited to:

  • Manual Therapy (soft tissue massage, neural mobilization, joint mobilization)
  • Education that is Person-Centered (e.g., biopsychosocial model of health and disease, self-efficacy beliefs, active coping strategies)
  • Stretching & Loading Programs (e.g., concentric, eccentric, isometric exercises)
  • Hydrotherapy (hot & cold)
  • Self-Management Strategies (e.g., engaging in physical activity and exercise, social activities, and healthy sleep habits)

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