Tendinopathy

What is tendinopathy?

Commonly referred to as “tendinitis,” overuse tendon injury, or tendinopathy, is a common cause of musculoskeletal pain.  Every muscle has a tendon, which can be thought of as a rope, across which the muscle exerts its force.  For example, the Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel, allowing them to push our foot down and propel us forward when running and upward when jumping. 

Where does tendinopathy occur?

The most common locations to experience tendinopathy are the shoulder, elbow, ankle, knee, and wrist. 

How does tendinopathy occur?

When we overuse a tendon in work or sport, small tears occur that require time for our body to rehabilitate.  Additionally, for tendons with coverings called tendon sheaths (e.g. many wrist and ankle tendons), fluid and inflammation can occur in response to overuse.  If a tendon is overused and not given time and proper stretching/exercises to heal, the areas of injury can begin to degenerate over time, similar to the joint degeneration seen in osteoarthritis.  Unlike osteoarthritis, degenerative tendinopathy, or tendinosis, can happen as young as in the 20’s.  Also unlike osteoarthritis, with proper treatment, tendinosis does not have to be a progressive condition that leads to surgery or permanent disability.

What training factors can predispose to tendinopathy?

Factors that contribute to tendon overuse and tendinopathy include improper warm-up and post-activity stretching, improper equipment (e.g. tennis racket or running shoe), rapid advancement of training schedule, muscle weakness/imbalance, and improper technique. 

What treatments are there for tendinopathy?

Traditional therapy for tendinopathy has focused on rest, icing, and over-the-counter medications (e.g. NSAIDs).  Additional treatment options for tendinopathy include individualized instruction in proper stretching and exercise, soft-tissue mobilization techniques, topical medications, and occasional bracing or injections that can help rehabilitate someone experiencing pain from tendinopathy.

What about PRP injections for tendinopathy?

Platelet-rich plasma (PRP) injections are usually performed for degenerative tendinopathy, or tendinosis, that has not responded to conservative therapy, as mentioned previously.  The vast majority of patients with tendinosis, after being properly diagnosed and treated, return to their desired level of activity without requiring specialized injections, like PRP.  However, for the minority of patients that do not respond fully to those treatments, PRP injections can be a good option and we will set up referrals to appropriate providers that perform PRP injections.  Because the research supporting PRP is still incomplete, most  insurance companies do not currently cover this procedure, meaning that it can cost anywhere from $400-2500 out of pocket, depending upon the number of injections performed. 

Hyaluronan - CECS - Tendinopathy