Tendon Pain
Achilles tendinitis, Jumper’s Knee, Tennis Elbow, Trochanteric Bursitis, Butt (sitting bone) pain…
Do you recognise any of these common conditions?
Or maybe you or someone you know suffers from one of the following complaints:
- a stiff and sore achilles in the morning or if you go for a run.
- pain beneath your knee when you play jumping sports like basketball.
- elbow pain when you pick things up or turn off the tap.
- an aching hip when you lie on your side in bed or walk up and down stairs.
If you do experience any of these complaints, then you may be suffering from tendon pain.
You’re not alone.
Suffering with tendon pain can clearly be frustrating and unpleasant and through experience can impact on work, family, sport and recreation as well as your mood. Your tendon pain actually represents one of the most common reasons people stop being active and seek help from their doctor or an experienced physiotherapist. And unfortunately rest alone is rarely the answer.
But our approach to helping people like you has changed. Tendon pain is rarely helped by long periods of rest and anti-inflammatories. And tendon pain doesn’t have to result in you stopping altogether the activities you enjoy, though you may need to moderate how much or how intensely you do for a period of time. In fact, it is often simple treatments and management strategies that can help you manage your tendon pain and remain engaged in the things that make life worth living.
How do I know this? Because it is what the researchers who study tendon pain have found and it is also my experience from over twenty-five years as a physiotherapist working with people with tendon pain. What’s more, how you manage your tendon pain does not usually need to involve expensive scans, fancy treatment techniques or surgery. Simple approaches can and do work. But it does take time and a commitment to performing a simple rehabilitation program.
Reading the professional information on this page and completing the self-assessment questionnaire might be a helpful start in making sense of the tendon pain you are experiencing.
- Achilles tendinopathy - Pain and stiffness in the achilles tendon
- Patellar tendinopathy - Pain at the bottom of the knee cap
- Gluteal tendinopathy - Pain on the outside of the hip (sometimes associated with a trochanteric bursitis)
- Hamstring tendinopathy - Pain at the top of the hamstring at the attachment to the sitting bone (ischial tuberosity) and often described as buttock pain.
- Tennis Elbow - Pain on the outside of the elbow
Red Flags.
Occasionally pain may be an indication of a more serious, underlying condition. Doctors and physiotherapists will ask a series of Red Flag questions to help guide their decision making but it is important to realise that Red Flags do not necessarily mean you have a serious underlying disorder, simply that you should consult your doctor for further assessment.Yellow flags.
It’s quite normal to feel a bit down or worried when you have pain and you shouldn’t feel guilty for this. However, what you believe, think and feel about your pain can have consequences on your recovery in very real ways.
These are sometimes referred to as Yellow Flags and should be discussed with a caring professional who takes the time to listen to you and understand your fears and concerns.
So, what should you do?
With a little knowledge, you can make some choices.
If you have concerns that you have Red Flags or Yellow Flags, you should seek further assessment from an experienced physiotherapist or your doctor. This can be done in person or effectively over telehealth.
What causes the pain and stiffness?
Tendons connect muscles to bones and are a crucial link in our movement system. During more vigorous sporting activities such as running and jumping, our tendons also act like elastic bands, and by stretching and recoiling help us spring and bounce. In athletic people it is often this elastic demand on our tendons that can lead to problems. And because tendons attach to bones, the tendon is also prone to be compressed against the adjacent bone, which can also aggravate a tendon. Sometimes tendons will be exposed to both elastic and compressive forces, which can be particularly provocative.
Maybe a simple way to think about your tendon is to view it as having a certain capacity for both elastic and compressive forces. If we exceed this capacity, for instance by increasing our running training too quickly (achilles tendon) or performing weekend DIY jobs with power tools that we are not used to (tennis elbow), the tendon can struggle to cope and adapt.
In most cases we now understand the tendon doesn’t necessarily become inflamed (these days we use the term tendinopathy rather than tendinitis), but changes in the tendon lead to feelings of pain and stiffness and overtime can lead to degenerative changes within the tendon. We also now understand that tendon pain is not always a simple case of overuse (sometimes it can actually be underuse!), and that other health and medical issues, such as inflammation and obesity can contribute. Certainly, you don’t have to be young or athletic to suffer tendon pain.
If you think you have tendon pain, follow this simple approach to manage your own recovery.
Our approach to managing most types of tendon pain has changed over the past couple of decades.
We now know that long periods of rest and anti-inflammatory medications are rarely the answer. And while injections can sometimes help ease the pain, particularly if there are associated problems such as bursitis, that same pain will often return.
The emphasis in managing tendon pain is now directed at identifying and then modifying the activities that aggravate your tendon pain (you can think of this as those activities which exceed the tendon’s capacity for elastic and compressive forces) and then performing a rehabilitation program to regain and then increase the capacity of the tendon so you are able to tolerate more of the activities you wish to do again. It may be counter intuitive, but the best way to manage your painful tendon is actually to exercise it, first gently and over time in more demanding ways. And time is the key.
Rehabilitating a tendon will often take three months or more. Sorry, but it’s better you know that up front!
Self-management of
tendon pain
- Education Learn more about your tendon pain, including the impact that other health issues such as weight and stress can have on your pain.
- Weight Control & Reduction Managing your weight can be a challenge but it is clear that excess weight increases the physical stress on tendons and can also contribute to changes in your metabolism which may be linked to tendon pain.
- Stay Generally Active People with tendon pain tend to become less active. Unfortunately, this can lead to an even greater loss of strength, capacity & willingness to do the things you want to do, so learning how to moderate and pace your activity in order to keep going is hugely important.
- Stay Strong! Strengthening the muscles which attach to your tendon (and ‘loading’ the tendon itself) can be the most effective way to reduce your pain and keep doing the things you want to do. There are numerous different exercise protocols you can perform. The key is developing a program which you feel able to perform and that you are confident helps you.
- Most tendon rehabilitation protocols will start with slower strength-based exercises, become progressively demanding over time and eventually incorporate exercises which are more closely associated with the sport or activity you wish to return to. Be consistent, progress slowly and above all be patient!
Don’t feel you’re getting better?
Sometimes people do need more help and support to manage pain and participate in the things that make life worthwhile.
An experienced physiotherapist should act as a coach, helping you:
- address the fears or concerns you have about your pain
- guide your understanding of your pain and stiffness
- work with you to discover how you can remain active and engaged
- help you determine the rehabilitation approach you are most able to perform and believe will help (there is no single magic exercise for everyone).
If you would like to learn more about Specialist Physiotherapist Matt Lancaster FACP and how to book an individual consultation:
A final thought.
You may well have wear and tear, bursitis or a degenerative tendon, but so do a lot of people who don’t always experience a high degree of pain and suffering. You may also have one leg a bit shorter than the other, believe you have terrible posture, been told you have a weak or lazy core, have gluteal muscles that are not active and don’t even work, that your spine is locked, your pelvis is out and your alignment is wonky, that your ying is at odds with your yang or that your fascia needs releasing because you are so tight it’s amazing you can even function and if someone doesn’t adjust
your spine every week for the next twelve months you’ll probably end up in a wheel chair!
Have you ever wondered what any of these things mean? Or if they are even real? How many people believe, or are told they have these problems but don’t experience your pain?
There are thousands of fancy approaches, magic treatments and bold claims on the internet. Not many of them are well supported by research, but most of them have the potential to cost you a lot of money. Health care should be delivered ethically. And sometimes keeping it simple and evidence-based is the best, most cost-effective thing we can do to help.