What are Tendons?
Tendons are the stretchy, white bands of connective tissue that are at the ends of muscle and connect the muscle to the bone.
How a Tendon Causes Pain
When a tendon is stretched or eccentrically overloaded, the fibers can tear. This is called strain. Other types of tendinopathy (disease of a tendon) include tendinitis and tendinosis. Tendinitis is acute inflammation of a tendon. Tendinosis is degeneration of the tendon fibers from repetitive microtrauma resulting in the development of abnormal tendon tissue. The commonality amongst these tendon problems is that they can all cause significant pain and dysfunction, keeping people from doing the recreational activities they need or the work that needs them.
Treating Tendon Pain
In the not-so-long-ago past, treatment plans for these tendon problems were very limited: rest, ice, compression and elevation were, and still are, the best initial therapeutics. NSAIDS and other medications and modalities are also used to reduce inflammation and can be very beneficial. Prescription medications and cortisone injections may have a limited role in persistent tendon pain or inflammation. However, nothing has been shown to be more effective than eccentric exercise in physical therapy at repairing damaged tendon.
What if Treatments Have Not Worked?
What do you do if none of these therapeutics have worked? From the 1970s-2000s, advanced treatment for tendinopathy was limited to surgery. Surgery is still the only clear fix for complete ruptures of tendons; meaning, if a tendon is torn in half, the only way to get perfect function is to reattach those two ends. However, performing surgery on strains (partial tears) that won’t heal, or refractory tendinoses, may actually be excessive.
Orthobiologic injections, such as Platelet Rich Plasma and Mesenchymal Stem Cells and minimally invasive techniques, such as percutaneous tenotomy, are revolutionizing the advanced treatment of tendinopathy.
Schedule an appointment with Dr. Manalac to discuss if one of these therapeutics might be appropriate for you and can get rid of your tendon pain once and for all.
Dr. Manalac is a non-surgical sports medicine physician who practices in Fort Lauderdale. For referral information, call 954-776-9517.