Tendinopathy is a term used to describe a tendon (which connects your muscles to the bone) that has changed in thickness and composition.

These changes generally occur through a combination of:

• overload (change/increase in level of activity)
• age-related changes in the tendon
• other health issues (being overweight, having diabetes, etc.).

It is usually not caused by a specific traumatic event (injury) and is a condition which gradually develops.

It can affect most tendons, but most commonly it affects:

• gluteal tendons (side of the hip)
• proximal hamstrings (buttock/sit bone)
• patellar tendon (knee)
• achilles tendon or tibialis posterior tendon (inner side of the ankle).
• plantar fascia (bottom of the heel).

What causes pain in tendinopathy?

There is debate within the research about what causes pain in tendinopathy.

It was thought to be related to inflammation, but studies have shown that inflammation plays a very small role in causing pain in this condition.

It is currently understood that altered tendon structure (thickening) is caused by a breakdown of collagen fibres.

As the body attempts to repair this breakdown, the number of cells called tenocytes within the tendon increases.

This also causes an increased amount of water within the tendon (which is why it becomes thicker).

Within this thickened area of the tendon, it is understood that there is an increased number of certain neurotransmitters (natural chemicals that transmit signals between nerve cells), which may be a cause of pain.

Factors that contribute to tendinopathy

Among these are:

• gender – it is more common in females than males
• age – most common between 40 and 60 years of age
• hormones – reduced oestrogen leads to a reduction in collagen fibre regeneration, which explains the increase in tendinopathy in women beyond the age of 40
• activities – it is common when increasing physical activity levels too quickly
• diabetes (especially when poorly controlled) also adversely affects collagen in tendon and bone and can make it more brittle
• medication – tendinopathy is also more common if you are taking certain medications (steroids, certain antibiotics and others).

How is it treated?

Research tells us that exercise and progressively increasing the strength in the muscles that attach to the tendon, as well as the muscles around the pelvis and hip, is the best way of improving tendinopathy in the long term.

Despite the changes mentioned above within the tendon structure, it is reassuring to know that many of these changes are reversible.

Exercises have been shown to reduce pain and improve function in patients with most types of tendinopathy, regardless of location.

Okay to exercise with pain

When you commence your exercise programme, it is common for you to experience some pain in and around the tendon.

It is safe for you to exercise with moderate pain (4/10 on a pain scale of 0 to 10).

The physiotherapists in the START programme will help guide you.

Exercises need to match the demand

The exercises needed can vary depending on the type of physical activity that an individual normally undertakes.

For example, if you are a runner, your exercise intensity will need to be increased over an eight to 12-week period to match the demands of running.

Specifics of the START programme

It will be run by our MCH physiotherapy team in the gym at MCH House.

There will be an educational aspect (through presentations led by our physiotherapists) as well as a guided exercise programme and progression through exercises.

As stated previously, the exercises you will be given will be based on your normal levels of activity.

You will attend six group sessions (with up to 10 people who also have tendinopathy in their leg) over a period of 12 weeks (fortnightly sessions).

How can you be referred to this programme?

You will be referred to this programme after assessment with the Clinical Assessment Service (CAS) or by a physiotherapist at your initial assessment session.

We expect that, with your active participation in this programme, you will make good progress and achieve improvements in pain and function.