Tendinopathy: Preventing & Treating Overuse Injuries during the Pandemic

A woman stops to check her sore knee while out for a run in a scenic setting

The COVID-19 pandemic has thrown everyone’s daily routines for a loop, as we’ve all been forced to adjust to a new normal. 

From new exercise routines and changes in sports schedules to an increase in “do-it-yourself” projects around the home, we’ve all dealt with pretty drastic changes to our day-to-day activity level.

As a result, we’ve seen a noticeable increase in injuries related to these changes in routine, namely overuse injuries.

One of the more common overuse injuries we’ve seen? Tendinopathies.

What is tendinopathy?

“Tendinopathy” is a generic description of a clinical condition associated with overuse of a tendon.

You’ve probably heard of some kinds of tendinopathy, including tendonitis, which refers to an inflammation in or around the tendon, or tendinosis, which is a slightly more evolved pathology that refers to degeneration of collagen fibers that makes up a tendon. 

Tendinopathy is a common injury. It can occur in people of all ages and walks of life, from elite athletes to the elderly, as it can come along with any degree of overuse. 

Common parts of the body affected by tendinopathy include: 

  • Rotator cuff tendinopathy in the shoulder
  • Lateral epicondylitis (more commonly known as tennis elbow)
  • Medial epicondylitis (more commonly known as golfer’s elbow)
  • Gluteal tendinopathy in the outside of the hip
  • Patellar tendinopathy (more commonly known as jumper’s knee)
  • Achilles’ tendinopathy at the ankle

What causes tendinopathy injuries?

In most cases, tendinopathy injuries will occur when a relative period of inactivity is followed by a period of increased activity — something that has been happening a lot during this pandemic.

Examples include:

  • Taking a sports season off and then starting the next preseason like you never missed a beat
  • Starting a big painting project in your house
  • Taking up cooking more than usual
  • Changing your workstation and work habits due to working from home
  • Changing or increasing your workouts or regular exercise routine

As you can see, tendinopathies don’t have to be related to playing a sport or running more than normal; overuse injuries can come from all manners of activity.

What’s the science behind tendinopathy injuries?

A woman in gym clothes rubs near her shoulder after experiencing pain while exercising

The tendons in our body have an ultimate capacity at which they can work; they also have a threshold at which pain presents.

Both the ultimate capacity and the pain threshold can change as the physical demands of your daily life or training change.

In a healthy individual, the ultimate capacity is usually quite high — most (if not all) of your normal activity would fall under that capacity. 

The initial onset of injury occurs when that pain threshold is surpassed either by chronic overuse or by some kind of incident, setting off what can be viewed as a vicious cycle:

  • With the pain threshold surpassed, you become more avoidant of using the affected limb.
  • Inactivity of the affected limb makes the tendon and attached muscle weaker.
  • Weakness and inactivity impact the ultimate capacity and pain threshold, which begin to decrease.

As a result of this cycle of pain and inactivity, what were once trivial or mindless tasks become painful.

How is tendinopathy treated?

The key to treating and managing tendinopathy is load management. 

This is a crucial note: absolute rest is not the answer!

Treating tendinopathies requires us to walk a fine line: we have to manage and limit the daily activity that climbs over that pain threshold while also doing enough work or activity to push us right up to that threshold.

This will allow us to steadily restore the capacity of the tendon and muscle complex in order to return to all prior level of function without pain. 

Use of modalities like steroid injection, ice, heat, massage, joint mobility, and stretching can be used to manage your symptoms in the early stages of your recovery. 

However, in order to elicit long-term change, progressing the strength capacity of the tendon/muscle complex is the answer!

If you’re dealing with an overuse injury, working with a physical therapist is a great way to get yourself back to full health.

Physical therapists are trained in the treatment of tendinopathies and can develop a treatment plan that will help you slowly strengthen your tendon and muscle without breaching that pain threshold.

South Shore Health offers physical therapy services at multiple locations across the South Shore. Please contact us for more information.

Rob Shirley, PT, DPT is a physical therapist at South Shore Health. Learn more about our Physical Therapy program.