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Best Tendinopathy Treatment In Delhi NCR.

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What is Tendinopathy ?

Tendinopathy is a broad umbrella term that describes any painful condition affecting a tendon. Tendons are tough, fibrous cords of connective tissue that attach muscles to bones, enabling movement.

Previously, many tendon pains were simply called “tendinitis” (or “tendonitis”), implying inflammation. Instead, there is often a degenerative process involving disorganization of collagen fibers, cell changes, and a lack of inflammatory cells.

Tendon Issues

“Tendinopathy” is a more accurate term to cover the spectrum of tendon issues, including:-

  • Tendinitis (or Tendonitis): This specifically refers to acute inflammation of a tendon, often due to a sudden injury or overload. It is characterized by the presence of inflammatory cells. While less common than once thought in chronic pain, it can occur in the early stages of an injury.
  • Tendinosis: This refers to chronic degeneration of the tendon’s collagen fibers, often due to repetitive overuse or failed healing. There is little to no inflammation, but rather a breakdown and disorganization of the tendon structure. This is often the underlying pathology in long-standing “tendinitis” cases.
  • Tenosynovitis: Inflammation of the synovial sheath that surrounds some tendons (e.g., in the wrist, hand, ankle).
Causes of Tendinopathy
Tendinopathy is almost always an overuse injury or a result of repetitive strain. It occurs when a tendon is subjected to loads beyond its capacity to adapt and repair, leading to microscopic tears and structural changes.Common causes and contributing factors include:-
  • Repetitive Motions: Performing the same movement repeatedly over time, such as those involved in:-
  • Sports: Throwing (shoulder, elbow), jumping (knee, Achilles), running (Achilles, patellar, gluteal), serving in tennis (shoulder, elbow), golfing (elbow, shoulder).
  • Occupations: Painters (shoulder), carpenters (elbow), typists (wrist), gardeners (wrist, elbow).
  • Sudden Increase in Load or Intensity: Abruptly increasing the duration, frequency, or intensity of an activity (e.g., starting a new running program too aggressively, suddenly increasing weightlifting).
  • Poor Biomechanics/Technique: Incorrect form during sports or daily activities can place excessive or abnormal stress on specific tendons.
  • Insufficient Recovery: Not allowing enough time for tendons to recover and adapt between training sessions or repetitive tasks.
  • Muscle Imbalances or Weakness: Weakness in muscles that support a joint or an imbalance between opposing muscle groups can put undue stress on tendons.
  • Aging: As people age, tendons naturally become less flexible and less tolerant to stress, making them more susceptible to injury.
  • Inadequate Equipment: Worn-out shoes, poorly fitted equipment, or unsuitable surfaces (e.g., running on hard concrete).
  • Underlying Medical Conditions: Certain systemic diseases can increase the risk of tendinopathy:-
    • Diabetes
    • Rheumatoid arthritis or other inflammatory arthropathies
    • Thyroid disorders
    • Gout
Common locations for tendinopathy include:-
  • Shoulder: Rotator cuff tendinopathy (supraspinatus, infraspinatus)
  • Elbow: Lateral epicondylopathy (tennis elbow), Medial epicondylopathy (golfer’s elbow)
  • Wrist/Hand: De Quervain’s tenosynovitis, trigger finger
  • Hip: Gluteal tendinopathy (trochanteric bursitis is often a symptom of this)
  • Knee: Patellar tendinopathy (jumper’s knee), Quadriceps tendinopathy
  • Ankle/Foot: Achilles tendinopathy, Peroneal tendinopathy, Tibialis posterior tendinopathy
Common locations for tendinopathy include:-

The symptoms of tendinopathy typically develop gradually and worsen over time. They are often most pronounced where the tendon attaches to the bone, or in the mid-portion of the tendon.

Common symptoms include:-

  • Pain: Usually a dull ache, but can be sharp, especially with movement or when touching the affected area. The pain often:
    • Worsens with activity involving the affected tendon.
    • May be present at rest, especially after activity.
    • Can be worse in the morning or after a period of inactivity (“start-up pain”).
    • Tenderness: The tendon is painful to touch or palpate.
  • Stiffness: Especially in the morning or after rest.
  • Weakness: Difficulty with movements or activities that involve the affected muscle-tendon unit.
  • Thickening or Lump: The affected tendon may feel thickened or have a small lump.
  • Crepitus: A grinding, cracking, or crunching sensation or sound when moving the joint or tendon (especially in tenosynovitis).
  • Mild Swelling: While inflammation is less common in chronic tendinopathy, some swelling or warmth might be present.
Advanced Physiotherapy for Tendinopathy
  • Isometric Exercises: Initial phase, especially for pain relief. Holding a muscle contraction without movement for 30-45 seconds, 3-5 repetitions, several times a day. This has an analgesic (pain-relieving) effect and helps maintain muscle activation without overloading the tendon.
  • Energy Storage/Release Exercises (Plyometrics): Introduced in later stages, once the tendon has built sufficient strength. These exercises involve quick stretch-shortening cycles (e.g., hopping, jumping, bounding, sprinting). They prepare the tendon for the demands of sport or high-impact activities. Progress from low-intensity to high-intensity, and low-volume to high-volume.
  • Sport/Activity-Specific Training: Gradually reintroducing movements specific to the patient’s sport or occupation, focusing on correct technique and controlled progression.
  • Manual Therapy: Manual therapy serves as an adjunct to exercise, often used to prepare tissues for loading, manage pain, and address secondary musculoskeletal dysfunctions.

Soft Tissue Mobilization:-

  • Deep Transverse Friction Massage : Applied directly to the tendon for a specific duration. Historically thought to break down scar tissue and promote healing, current understanding suggests it may help with pain modulation and improving local blood flow.
  • Myofascial Release / Deep Tissue Massage: To address trigger points, tightness, or restrictions in the muscle belly, fascia, or surrounding soft tissues that might be contributing to increased tension on the tendon or altered biomechanics. E.g., releasing tight calf muscles in Achilles tendinopathy.
  • Instrument-Assisted Soft Tissue Mobilization (IASTM) / Dry Needling: Used by trained therapists to address local tissue restrictions, improve blood flow, and reduce pain.

Joint Mobilizations:-

  • If there are joint stiffnesses or dysfunctions (e.g., in the shoulder, ankle, hip, or even spinal segments like the cervical or thoracic spine) that contribute to altered movement patterns and overload the tendon, the physiotherapist may use gentle joint mobilizations (Grades I-IV) to restore normal joint play and range of motion. For example, thoracic spine mobilization for shoulder tendinopathy, or ankle/midfoot mobilization for Achilles tendinopathy.
  • Mobilization with Movement (MWM): A technique where the therapist applies a sustained accessory glide to a joint while the patient actively moves the limb through a pain-free range. This can be particularly effective for conditions like tennis elbow to immediately improve pain-free grip strength and range of motion.
  • Modalities: Ice for acute pain/swelling, heat for muscle relaxation before exercise. Therapeutic ultrasound, laser, or electrical stimulation may be used for pain relief and tissue healing, though their primary role is supportive.

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