Please find below a variety of different resources that will help aid in the management of your condition. The top three resources are videos that the Physiotherapy department have created to help with strengthening and mobility for various areas of the body. Below these are further resources regarding helpful information and links to further information if you would like to find out more.
Back Pain Video Exercise Class
Hip and lower limb Video Exercise Class
Shoulder Pain Video Exercise Class
Tendinopathy Patient Information:
What is Tendinopathy?
Tendinopathy is the medical term for a condition affecting the tendon. A tendon is a soft tissue structure that attaches muscle to bone.
The condition used to be referred to as tendonitis, with “itis” meaning inflammation. However, research over the last 10 years or so, has helped us to understand that this is not a simple inflammatory condition. So, this has changed what we call it, and how we treat it.
We also now know that scans are not generally helpful in aiding diagnosis or management of tendinopathy. Findings on ultrasound are usually normal age-related differences, just like wrinkles or grey hair, but on the inside.
Where does it hurt?
Tendinopathies are commonly observed in the lower and the upper extremities of the body.
In the upper limb this may present in the shoulder (rotator cuff) or in the elbow (tennis elbow and golfers elbow).
In the lower limb the most common tendinopathies occur at the heel (plantar fascia and achilles tendon), the hip/buttock (that is, the gluteal tendon), the knee (patellar tendon) and the ankle (tibialis posterior tendon). (?picture here)
Tendinopathy can be classified in to 2 Subgroups:
- Reactive Tendinopathy: The tendon may feel swollen, warm, stiff and painful. This may be your first experience of tendon pain, usually after “over doing it”. For example, after an unaccustomed activity such as a DIY project, or a strenuous bout of gardening. Or perhaps after taking on a new exercise, or increasing the speed or pace of your usual exercise quite rapidly. Anti-inflammatories may help a bit, as will initial rest from the activity.
- Degenerative Tendinopathy: Symptoms may have come on quite gradually as an ache, that used to come and go and has got gradually more debilitating, over quite a few months. Typical treatment such as rest, ice, anti-inflammatories, rest or injections may have worked for a short time, but the problem keeps returning. The affected tendon may appear thickened and stiff. It might be hard to pin-point what caused it.
Reactive tendinopathies can develop to degenerative tendinopathies when the individual is not able to change the activity which started the pain.
All tendinopathies are caused by overloading the tendon. The tendon has been excessively used in some way, without enough recovery time. Be that a short bout of unaccustomed heavy work, or prolonged repetitive lower grade activity. Put simply, your tendon is not keeping up!
The tendon thickens to protect itself. But this thickened tendon is not good strong tissue. So rather than getting stronger, you will find the tendon feels like it is getting more painful and weaker, so everyday movements and activities become harder to do.
Other factors: Age, being overweight, menopause, and having high cholesterol can also sometimes influence tendon health, as can a few medications such as some anti-biotics, statins and steroids. These may make you more sensitive to tendon pain with only a subtle change in your activities.
How to Improve Your Tendon Pain:
1. Calm Things Down.
Try to identify what is causing the excess load through the tendon and modify your activities. But avoid complete rest as this weakens the tendon further.
It may be simple to identify what has caused the pain if it came on after a memorable bout of activity.
It will be harder to identify what caused it, if the pain came on more gradually.
Tips for Upper limb pain: Consider what small repetitive movements you do in your day and whether these could be changed. If you are at a computer quite a lot, check your ergonomics. Ensure your chair and desk are the right height for you and that you have a wrist support or arm rests. Are you over-reaching for the mouse? Would a vertical mouse be more comfortable?
Are you over stretching your arm in other ways and could this be changed?
Are you holding your mobile phone with your elbow and wrist bent for long periods and could this be changed?
Are you taking regular breaks from your screen? Every 30 minutes is recommended.
Tips for Lower Limb Pain: Tendons in the lower limb often have to work too hard if foot-wear is not supportive enough.
A change to less supportive footwear in the summer (e.g. flip flops) or trainers that are well past their best, can start to make the tendons work harder to support the foot, causing tendinopathy symptoms over time. People on their feet all day may benefit from wearing good lace up, supportive footwear.Arch support insoles can also sometimes help.
2. Build Things back UP!
Exercise is the current most evidence-based form of treatment for tendinopathy.
Since research has improved our understanding of tendinopathy we now know that passive treatments such as massage, and ultrasound do not really have a long term impact on the tendon, so current experts in the field do not recommend these treatments, for the majority of patients.
Improving the strength and condition of the tendon through exercise is the single most important part of treatment, as only this stimulus will improve the tendon’s ability take more load, and therefore improve pain.
But, the exercise needs to be customised to the individual so that they are able to introduce the tendon to exercises very gradually, building it up, bit by bit to become more resilient and less painful.
3 Key Principles of Exercise:
- Start gently and build up gradually. There is no “one-size-fits-all” exercise programme. Your physiotherapist will help guide you on where to start and that may be different depending on how sensitive the tendon is.
- You need to monitor pain. It’s ok for exercises to be a little painful in order to work hard enough for improvement to occur. However, the pain should not be horrible. On a scale 0-10 (0 being no pain) do not push yourself harder than 4-5/10. If in doubt, go easier on yourself, as tendons often react to exercise 24 hours later. If after 24 hours the pain has settled well, then you have got it about right. Now try to increase how much you do a little more each time. If however, it is more painful or stiff after 24 hours, go easier on yourself next time; reduce the amount you do and then build back up again.
- Be patient. Tendons respond slowly to exercise. It can take at least 12 weeks to have a good affect and may take longer if you were very sensitive to exercising to start with.
However, stick at it and this consistent approach will enable you to effectively restore the strength and function of the tendon, to help you to achieve your goals!
Want to learn more?
Local aids and Red Cross
Please find below downloadable advice regarding mobility aids that the red cross can provide:
Please find below further information for Support at Home throughtout Norfolk: