Chronic Tendon Injuries

The biggest change I have noticed in the treatment of chronic tendon injuries over the last 10 years is the understanding of the pathology involved. I am talking about rotator cuff tendon problems, tennis elbow, patellar tendinopathy and Achilles tendinopathy. Whereas in the past people believed that this was an inflammatory condition now it is proven that this is a disease caused by micro tearing. All tissues have their breaking point and when this is reached fibres will start to tear. For some of the fibres in the tendon this breaking point is reached sooner and so some of these fibres break down leading to micro tearing.

Waterford Tendon talk

The important point is that this injury does not produce an inflammatory reaction and without inflammation there is no healing response. Tendons have a poor blood supply and therefore their capacity to heal is poor. These injuries do not adequately heal because there is not a proper inflammatory response produced. It takes a bit of a leap to get away from the idea that these tissues are inflamed and need to be rested, cooled and anti-inflammatories should be taken to instead going for a supervised rehab programme with possible extracorporeal shock wave therapy and possible autologous platelet injections to promote the inflammatory response and healing.

Non steroidal anti inflammatory drugs are used to get rid of the dreaded inflammation that so many people are keen to treat. Instead people should start to see inflammation as the body’s reaction to injury and is essential to healing. Sometimes inflammation can get out of control and needs to be reduced but we should be careful not to be so fast to reach for the tablets. The same goes of course for the steroid injections.

Even surgery can be required to promote healing. All forms of treatment seek to produce more of a response from the body.

So the message in chronic tendon injury is that we need to help the body to heal itself. That means promoting the natural inflammatory response and getting a new mindset in thinking about these injuries.