Recovering from tendonitis has progressed in a very remarkable way in the last decade. The best characteristic of this pathology improved management, which has always been difficult. It is now considered more appropriate to talk about tendinopathy rather than tendonitis, and the approach is more active rather than rest oriented.
The concept of tendonitis is not justified, since it refers only to an inflammatory process. As pointed out by Gustavo Paseiro Ares, a physical therapist and member of the steering committee of the Council of College of Physiotherapists, “the latest data warns of changes in the component that are also degenerative.” In this sense, the term tendinopathy encompasses “both inflammatory and degenerative changes, as well as those other conditions in which pain may exist in the absence of the above changes.”
One of the important questions that have been tried to unravel in recent decades is the relationship between tendon function and the amount of damage. Today it is known that “there is no direct relationship between the level of impairment, which can be demonstrated, for example, with a visualization test, and current function or pain,” says the physiotherapist.
This finding has led to direct treatment in the direction of strategies more focused on improving function and pain than tissue repair. For this reason, “the treatments currently in use are markedly active in trying to improve the response of the tendon to the stress it is subjected to.”
Exercises to improve the function
Paseiro explains why active treatments are chosen: “The tendon is made up of a major protein: collagen. This protein gives it elasticity as well as stability. One of the phenomena that occurs when someone suffers from tendinopathy is a change in collagen, which can affect that tendon’s ability to withstand the stress it receives. “
In this situation, “rest can contribute to tendon deterioration and increased pain and dysfunction,” so recovery strategies should be based on “exercise prescribed by a physical therapist that monitors the response of symptoms to increased stress.
What exercises should you do? “There is a lot of controversy as to which form of exercise is best,” says Paseiro. This will largely depend on the phase the tendinopathy is in.
At first, the most frequently used is “muscle work with slow and prolonged eccentric contractions”. In addition, isometric work is used to control pain.
After the acute or more reactive phase has been overcome, you should “progress in the load to work out strength and speed, ending with plyometric work, which allows you to readjust the power of the tendon to store and release energy.” / p>
In addition to muscle work, there are invasive physiotherapy procedures that can provide additional help in the treatment of tendinopathies such as electrolysis with eohydrolysis or dry puncture.
Phase is important, not localization of tendinopathy
What exercises are recommended for tendinitis of the shoulder, elbow, knee pad, or wrist? The expert replies that the choice will depend “more on the phase in which the tendon is located than on the location of the tendinopathy.” Thus, he distinguishes two main types of control:
If we are in the reactive phase, it is necessary to reduce the stress that aggravate the symptoms and begin an isometric contraction exercise program to realign the tendon to a stress that will be applied gradually.
If this is a degenerative phase, it will be necessary to advance with more intense contractions, including strength work, and then progress in speed and “request the tendon to increase the elastic load.” “.
Exercise tables should always be “personalized according to the subject, its morphology, its lifestyle and current pathological situation,” the physiotherapist concludes.