Tendinopathies: Early diagnosis and advanced treatments

Tendons are a fibrous connective tissue that connect muscles to bones. The tendon is a nearly avascular tissue, resulting in very limited blood supply. Consequently, during any inflammatory or degenerative process, the tendon undergoes stress and is often difficult to heal.

Tendinous injuries can stem from multiple factors, though they are typically caused by repetitive motions or microtraumas. These tissues are also highly susceptible to damage from chemical agents, like certain antibiotics and corticosteroids. The degenerative process of a tendon injury progresses very quickly. Medically, we transition from referring to “tendinitis” (acute tendon inflammation) to “tendinosis” (chronic tendon injury) within just three weeks. If the tissue has not healed by then, recovery becomes much more difficult, and the condition tends to become chronic.

In tendinitis, the inflammatory response increases the release of cytokines like IL-1β, which reduces the expression of type I collagen mRNA in human tenocytes, leading to the degeneration of the tendon’s extracellular matrix. The body’s repair process triggers an increase in type III collagen, replacing the type I collagen present in healthy tendons. This shift in collagen fibrils causes changes in the structure, consistency, thickness, elasticity, tone, and strength of the injured tendon, as type III collagen is not effective for tendon function.

This physiological healing action of our organism will cause the injury to become complicated, chronic and irreversible in just a few days, potentially resulting in acomplete tendon rupture. Consequently, swift evaluation and treatment of the injured tendon are critical to avoid irreversible damage. If a tendon injury does not show improvement after 3-4 days of rest, it is crucial to have a specialist assess it, as addressing the issue early significantly enhances the chances of a successful recovery.

Cortisone injections and oral cortisone can provide pain relief, but they also disrupt the proper regenerative and healing processes, which can lead to further degeneration and weakness of the tendon. Likewise, surgical procedures in complicated cases or significant and complete ruptures that impair tendon function will not recover its collagen cellularity, resulting in the development of fibrous, rigid, and less elastic tissue.

At Sportcat, we provide treatments utilizing deep hyperthermia UHF or high-intensity laser therapy, depending on whether the tendon injury also affects the joints or cartilage. Our approach includes cellular-level stimulation of tenocytes through MBST® magnetic resonance therapy. We will enhance deep vascular and lymphatic circulation with intermittent vacuum therapy (Vacusport®) and complement this with ultrasound-guided PRP (platelet-rich plasma) injections.

The results are remarkable, regardless of the timing of the injury. In cases of chronic injuries, we can reverse a substantial amount of the degenerated tissue, bringing it back to a robust and functional tendon. However, it is crucial to keep in mind the repeatedly stated point: the earlier recovery starts, the fewer irreversible effects will remain.

Once the tissue has healed, the recovery process transitions into a second physical phase. It is essential to work on the joint and muscle areas, increasing elasticity while also improving proprioception and nerve coordination in the affected region. Additionally, it is important to analyze the mechanism of the injury to prevent re-injury whenever possible. In cases of lower extremity injuries, conducting biomechanical assessments and evaluating the necessity for corrections with foot orthotics (insoles) is strongly advised.

A successful rehabilitation for a tendon injury usually involves 10 to 20 sessions (based on the level of degeneration), with at least 2 sessions each week. The collagen regeneration process will start to take effect from the third week of treatment.

This story is part of Nafent Magazine volume 12. Read the full story in our digital or paper magazine. Go to our webshop to get yours.