Tendinopathy the importance of staging and role of compression

In recent years our understanding of the pathology of tendinopathy has grown – we now know that it isn't really an inflammatory process (although inflammation may be present depending on where the injury is on the tissue damage continuum) and that load plays a large role. We also know that it's important to determine the 'stage' of the tendinopathy and this will have a huge influence on how you manage it.

Jill Cook and Craig Purdam have been at the forefront of tendinopathy research for some years. Their 2009 paper outlined a model that describes 3 different stages of tendinopathy: reactive tendinopathy, tendon dysrepair and degenerative tendinopathy. It is helpful to think of these as a 'continuum' rather than 3 completely distinct phases.

Reactive tendinopathy typically involves the tendon responding to a rapid increase in loading. For runners this often means a large increase in mileage, a reduction of rest days or a change in training type (e.g. Introducing hill or speed work). It can also be from direct trauma to a tendon.

It was thought that this reaction involved inflammation but we now understand that this is not the case. The tendon does swell but this is due to movement of water into the tendon matrix* and not inflammatory products. A key feature of a reactive tendon is that structurally it remains intact and there is minimal change in collagen integrity. Cutting the jargon  this means this is usually a reversible process.

Cook and Purdam (2009) describe it as,

“A short term adaptation to overload that thickens the tendon, reduces stress and increases stiffness”

Today my guest is Tom Goom, the Running Physio himself! Please check out his excellent website here, and enjoy this fantastic overview of our current knowledge of the management of tendinopathy, read on...

Simon Bartold
Director of Bartold Clinical