Chronic tendon pain: no signs of chemical inflammation. Implications for treatment?

Tendons are renowned sources of chronic symptoms in a wide range of upper and lower-limb disorders. This is not chronic inflammation, as inflammatory cells are never found in this degenerated tissue.

With continued prolonged or repetitive loading, micro-trauma in a tendon may result and an inflammatory response is triggered, the first stage on the road to recovery. This is followed by tissue repair and remodeling if all goes well. The entire process cannot be avoided or speeded up, but it can be impaired, and inappropriate behavior can prevent the remodeling, which should return the tissues to normal function. Mechanical forces are essential to this process and sometimes ignorance, bad advice, or fear of doing further damage constrains individuals from doing what is best. The period when relative rest is appropriate, during the inflammatory stage, is very short. In fact, a large proportion of patients seen by physiotherapists are seen at a much later stage when rest is absolutely contraindicated.

Only through exposure to mechanical loading can remodeling occur, deconditioned structures be made functional, and sensitized tissue be made normal. This is only achieved with regular exercise that challenges the unfit tissue.

No pill, lotion, or electronic gadgetry can even begin to promote this change, and to pretend otherwise is to condemn patients to continued suffering. Improvement in the state of the structure and the confidence of the patient to use it can only be brought about by gradually exposing the tissue to loading and movement.

An extract from ” The Human Extremities, Mechanical Diagnosis and Therapy” by Robin McKenzie and Stephen May 2000

knowledge … self-management … prevention