The management of tendinopathy has changed markedly since Fairfield Physiotherapy opened its doors on 1985. Even the name of this condition has changed from tendonitis to tendinopathy.
In the past, tendonitis was thought to be inflammation of a tendon. Now it understood that tendinopathy is not an inflammatory process but one where the structure of the tendon is compromised and cannot withstand the load placed on it. Tendinopathy can occur in the upper and lower limbs. It can occur as a one-off event over a short period, or as a repetitive strain injury over a longer period. Common sites are achilles tendinopathy, patella tendinopathy, gluteal tendinopathy, rotator cuff tendinopathy, tennis elbow and De Quervains disease of the thumb extensor tendon. The common feature in all tendinopathy is that something has changed in the loading pattern of the tendon and has induced a painful response.
Physiotherapists at Fairfield Physiotherapy are trained to listen to the patient’s story and establish if there has been a change in the loading pattern which would explain the presenting symptoms. For a runner or recreational walker with achilles tendinopathy, this could be as simple as a change in footwear or a different running route. A tennis player with elbow soreness, a new racquet or change of service action may be the trigger. An office worker may have had a busier schedule or a change in office setup giving rise to tennis elbow or rotator cuff tendinopathy.
The physiotherapist will perform a physical examination concentrating not only on the local area of pain but also the whole body or kinetic chain to establish a diagnosis and management plan for the patient’s condition.
Tendinopathy management revolves around establishing a cause for the patient’s presentation and devising a progressive loading campaign to ensure that the tendon is able to withstand the load required. An assessment of the whole-body movement eg gait or running assessment, or lower limb strength may be necessary and if appropriate will be addressed. Manual therapy may also be incorporated into tendinopathy management at Fairfield Physiotherapy. The physiotherapist will educate patients that most tendinopathies are not a quick fix and will require a partnership over three to six months to return to optimal tendon health.