Degenerative Tendinopathy is the end stage classification of a tendon injury. The tendon has been through the Reactive (Stage 1) & Dysrepair (Stage 2) stages.
As we discussed in part 1 &2, the constant battle to return to baseline is occurring. The tendon has the ability to do this but for only so long. If we continue to overload the tendons, we end up tiring the specialist tendon cells (tenocytes) and they are unable to lay down the “rolls royce” collagen and we end up with interspersed areas of the tendon that die off.
Don’t panic, there are still parts of the tendon that are intact, even in this final stage (in most cases). On imaging it is clearly seen that the tendon is thickened and nodular.
In the Body Balance Clinic we can palpate this too. Typically, this happens in the older athlete or patient whom has been through stages 1 and 2 for some time.
However, I have seen a case of this in a young sprinter who just refused to rest and take the advice of professionals around them. With all that said, as mentioned there are often still areas within the tendon which haven’t died, so it is well worth continuing to strength and train those tendons to make the most out of what tendon is left. The key is relative rest and not overloading too quickly, as it is comparably not as high functioning as it once was.
The image above illustrates the differences that can be observed on a cellular level, which help support what we’ve shared with you.
REFERENCES:
- Maffulli N, Sharma P, Luscombe KL. Achilles tendinopathy: aetiology and management. Journal of The Royal Society of medicine 2004;97:472–476
- Khan K 2007. New Laboratory Insights into the pathogenesis in tendinopathy
- Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine 2009;43:409–416