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Achillie tendinopathy

IT’S A NEW YEAR!!

With the New Year comes all the New Year’s resolutions.
With New Year’s resolutions comes a spike in exercise regimes and a spike in overuse injuries!!

This is the time of year as physiotherapist, we see the most cases of tendon pain.

Now, I could write a book on tendon pain. This is because there are often a number of factors involved and many presentations or STAGES of tendon pain.

There has also been a lot of debate in the research literature about the cause of the pain and how to best manage it.

The most common tendon pain conditions

Achilles tendon pain (ankle)
Patella tendon pain (knee)
Gluteal tendon pain (hip)
Rotator cuff tendon pain (shoulder)

What causes it?

Often doing an activity that you don’t normally ie.
Running, walking up-hills/beach/longer than normal, painting the house, spring cleaning etc.

Or increasing the load of an activity you are familiar with ie.
Increased weight, distance, intensity, speed, duration etc

Tendon pain can come on suddenly (acute) or over time. How the pain starts is important to how we best treat the pain.

There are 3 proposed stages of tendon pain:

REACTIVE (acute/sudden onset)
DYSREPAIR (pain came, went and now it comes and goes)
– DEGENERATIVE (due to the degenerative changes in the tendon make-up/longer term)

How do you identify tendon pain? 
1. Pain will be located at site of tendon– front of knee, back of heel/Achilles, side of hip, front/side/back of shoulder
2. Pain comes on with exercise (load) OR 24 hr after/ next day (latent pain)
3. If acute there may be swelling around the area (usually only with Achillies or Knee)
How do you manage tendon pain?
1. Allow adequate rest before loading the tendon again- tendon needs time to recover
2. Return to exercise at a lower load/intensity to gently reintroduce load to the tendon again
3. FIND THE TENDON’S SWEET SPOT AND PROGRESS SLOWLY FROM THERE– Find a load and intensity that does not cause pain and stay here. Progressively increase the load and intensity at a level the tendon can handle
4. If not settling, a bio-mechanical analysis to assess underlying imbalances in strength/motor control – Whilst there are underlying issues your training will ALWAYS be limited to how much you can progress.

Early identification is important BUT prevention is IDEAL!

KEY MESSAGES:
1. Identify potential tendon pain by the common locations- Achilles, Knee, Hip or Shoulder.
2. 3 stages of tendon pain and each stage requires a slightly different approach to treatment
3. Tendons are load specific structures so you know where to look if you are getting tendon pain…. LOADING
4.  Early identification is important BUT prevention is IDEAL!

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