Tendinopathy – also called tendonitis or RSI – can be a very painful and disabling condition. It can happen around any tendon in the body, such as around the knees (patellar tendinopathy) or forearms (tennis & golfer’s elbow). Tendinopathy in basic terms is a painful tendon reacting poorly to load which impedes the normal healing process and leads to inflammation in the tendon and eventually degeneration in the tendon structure. Tendinopathy severity is a continuum, but the majority of milder cases are reversible and short-lived.
Tendinopathies are often complex conditions that are affected by multiple factors including training load and the location of the tendon. I will be focusing on Patellar tendinopathy today, which affects the patella tendon at the front of the knee. While management of tendinopathy throughout the body can be mostly generalised to other body parts, some areas may differ in how they are managed. Management of patellar tendinopathy can differ from management of tendinopathy in the hand for example, and I would highly recommend consulting a Physio for more specific guidance, as every case is different.
What causes tendinopathy?
The root cause of tendinopathy is an inability of the tendon to cope with the load it has been taking. This can be acute like when you play an intense game of basketball after not exercising in 6 months, or it can be chronic – where a knee pain gets slowly worse over the course of a full footy season. The first onset acute stage often recovers without complications, but in longstanding chronic cases this can lead to degeneration in the tendon health if not taken care of.
How can I treat it?
The general rehabilitation for patellar tendinopathy can be broken down into 3 simple phases:
- Calm the pain down
- Build it back up
- Gradually get back to activity/sport
Calming the pain down
In most cases, a short period of rest is usually encouraged to help reduce the pain. This usually only lasts for a few days. You can also try either ice or heat which may help ease symptoms. Early treatment in-clinic may also help to further reduce pain.
In mild causes the pain usually subsides quickly, and people often bounce back into sport with no issues, however this may be detrimental long term if the pain continues to recur.
A gradual progressive rehab before returning to activity is important, as this is often the reason why chronic tendinopathy seems to never recover. One common mistake people tend to do is to completely rest until the pain improves. While a short period of rest is recommended, tendons do require rehab and gradual exercise to stimulate healing and recovery, even if there is a little bit of pain!
Building it back up
Exercise – particularly slow heavy loads have been shown to have good effect in most situations
Due to the nature of tendinopathy often requiring loaded stimulation to recover, we do allow for some pain during exercise, provided it does not hurt too much or linger on for too long after exercise.
A good general rule is nothing more than a moderate amount of pain, and the pain doesn’t linger on for more than a day.
Here are 2 potential exercises to try:
- Bench Squats
- Slow on the way up and down
- Try putting ¾ weight on one side or single leg if not too painful
- Aim for 3x 8-10 reps
- Slow on the way up and down
- 3x 8-10 reps per leg
Try these once every 2-3 days.
Return to sport/activity
Once the knee strength returns to normal and there is little to no pain with day-to-day activities, we start looking into returning to sport/activity. This will involve progressions in strength exercises alongside a slow and gradual return to aggravating activities.
The whole process commonly takes 4-6 weeks to fully recover with most people looking to return to activity somewhere in the middle.
As tendinopathy is often a complex process, as always for optimal recovery and rehabilitation it is recommended to come in and see a physiotherapist to find out how to best manage your knee pain!
Written by Jedidiah Lee.