Tricky Tendons

Tricky Tendons

Tendons! We`ve all heard about them, and kind of know what they do. In the past majority of tendon pain was given the term tendonitis/tendinosis, as it was believed that as there is pain there must be inflammation present. A study done by Cook and Pardum (2009) suggested that tendons can be painful without the presence of inflammation. And that the term tendinopathy be used instead.
tendon pain

They went further to say that tendons go through the “tendon continuum” Cook and Pardum (2015) meaning at any given time we all will be in this continuum

The study suggested that there are 3 main areas of tendinopathies

  1. REACTIVE This is the first stage of the tendon continuum, and it is without inflammation as ell as a proliferative response to tensile load or compressive to the cell matrix. Meaning it excels at a rapid rate. Here the cytoplasm (areas within the cells) increase organelles (living cells within the cell wall) increase protein production. In this process the collagen strength stays the same, however there is shown to be some increased elongation and separation between the fibres. This is a relatively short period of adaptation that increases tendon diameter to increase stiffness and reduce stress as a result. This change can occur due to a sudden increase in stress on the tendon or a direct impact. At this stage the tendon can revert back to a healed state given enough de-load.

  2. DYSREPAIR A progression from reactive to disrepair will occur if the tendon has not been effectively de-loaded. Increase in the proteins create further separation of the collagen. In this stage the damage to the tendon can be seen on MRI and ultrasound. Pain is believed to be from the increase in new neural (nerve) and vascularization (blood vessels) in the tendinopathic tendons.

  3. DEGENERATIVE This is the final stage in the continuum. Once this stage has been reached there is no possibility of reversing the damage. There is evidence to suggest that there is a lot of cell death in areas, increased nodules along the tendon. Typically this stage is present in older individuals where there is not much flexibility in the tendon, or a young individual that has continued to overload the tendon.


  1. Firstly we need to get the issue assessed by a relevant person, to rule out any red flags, and to get a full case history.
  2. Next we need to find the aggravating factors.
  3. Reduce/increase loads to manage pain and symptoms
  4. Work out a rehab plan to gradually expose the tendon to load, and ultimately adapt
  5. Its important to remember that tendons can take some time to a treatment plan, its not uncommon for changes to take a few weeks. Its important that you stick at it, you may find that your function increases as the pain/symptoms stay roughly the same, soon the pain will reduce and the function will further increase.



Mike Grice course material

Synergist Movement Therapy


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