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Tendon Injuries Physiotherapy & Hand Therapy
Tendon pains and injuries are very common "bread and butter" conditions
that our principal physiotherapists, hand therapists, TCM physicians and
massage therapists treat - unfortunately, tendon issues and pains are
one of those kind of pains most people will experience at least once in
For some, tendon injuries and pains may be prolonged, lasting for weeks or even months.
We treat many patients who are worried about their scans and ultrasound findings that suggest they may have degenerative changes in their tendons.
Good news is that research is showing that even for tendons with degeneration, there are plenty of healthy tendons that are capable of being trained, strengthened and exercise and can help the patient recover from their tendon injuries and pains.
first of all....Do Tendon injuries and pains even heal?
This is the #1 concern that patients have - IF their tendon damage will heal or not.
So first, let's dive deeper on the difference between
- physical direct damage such as partial or fully torn tendon versus
- tendinopathy and tendinitis (will cover these below)
let's talk about physical direct damage.
Of course, 100% tendon tear (medically termed as a full rupture) is technically
the worst, and the lesser the degree of tear, the better the situation
(ideally no damage preferred heh, but accidents do happen and that's why
we're here to help).
To put things in perspective, tendons are
unlike muscles, which are rich in blood supply (hence their red color);
tendons instead are whitish and have poor blood supply. This means
they're really good and strong BUT when they get damaged, they heal
slowly due to having poor blood supply (blood carries restorative
Full tendon tears cannot heal on its own normally (the only exception
being a mallet finger that can be treated conservatively with a
relatively simple customized anti-mallet splint) and will 100% require
What are the symptoms of a torn tendon?
When a tendon completely tears (100%), patients usually can feel or
hear something go "pop" or "snap", followed by lots of swelling and
The joint that is attached to the tendon will no longer work normally
For example, a patient with a ruptured biceps tendon will no longer be able to bend their elbow effectively.
What is tendinopathy?
Tendinopathy is by far the most common type of tendon injury.
Tendinopathy refers to the tendon being in a state of overload which presents as pain. Contrary to common belief, the tendon is usually not
inflamed and this is why we no longer use the term ‘tendonitis’, as the
‘itis’ means inflammation, which is generally incorrect.
of this distinction is that an inflamed tendon will need some rest, and
possibly some anti-inflammatories, to help settle it down before doing
any strengthening exercises.
An overloaded tendon in a state of tendinopathy
may feel better when resting, the problem will be there waiting for you
when you start exercising again.
This is why patients tend to feel frustratedly stuck in a
vicious cycle where they rest and then start exercising when their pain
has settled, only to find the pain returns and often comes on more
easily this time.
This is both confusing and frustrating for patients
but can be explained in that the tendon has become weak through resting
and disuse and therefore its tolerance to loading has reduced, making
it overload more easily.
Therefore, a patient with tendinopathy will respond better to a
rehabilitation regime consisting of graduating strengthening exercises that
gradually increase the tendon’s tolerance to loading over time.
The take home message here is that if you have tendinopathy, then
your tendon does not need rest, it will need a graduated strengthening
program usually over an 8-12 (give or take) week period.
It is important that these
exercises are prescribed by our principal physiotherapists and hand therapists with specific expertise in
treating tendon problems.
What is Tendonitis?
Tendonitis occurs when a tendon becomes inflamed.
Patients may experience on-off swelling too. Tendinitis is more rare and the more accurate term tendinopathy is used nowadays for a tendon
injury that does not involve a torn tendon [see above].
Whether there is
inflammation or not, the tendon has been overloaded and needs activity
modification and then will likely also need to be strengthened to allow
it to tolerate the exercise which caused the overload in the first
Therefore, tendonitis is treated as tendinopathy.
A graduated exercise program is the best way to avoid tendon problems.
What causes tendon injuries?
Tendon injuries result when
- repetitive load / strain
- one-time overload
exceeds the specific's tendon tolerance for load.
Tendon tolerance to
load is dependent on your activity profile.
Whose achilles tendon has higher tendon load?
- Person A: been a runner for 5 years, running three
times per week
- Person B: only walks every day and does not run for
It's more likely Person A, as their achilles tendon have been more conditioned to take more load and force over a period of time.
This also means that if person B decided to take up running, they would need to
gradually increase their running distances to reduce the likelihood of
overloading their tendon.
Other less common causes of tendon injuries include
- a direct
blow to the tendon (such as a kick, twist or an accident) or
- highly repetitive friction such as may occur
with a pair of shoes that rub on your heel / Achilles region.
How is a tendon injury diagnosed?
Most tendon injuries can be diagnosed in the clinic by an appropriately
skilled clinician - our principal physiotherapists and hand therapists can do it, but we prefer that you consult an orthopedic surgeon or sports doctor just in case they want to order an imaging (MRI, X-Ray or ultrasound) to have more clarity.
If ultrasound imaging is done, we recommend patients do BOTH left and right side ultrasound (even if only one side is painful) so that we can compare what is normal and what isn't. Of course, we may find some tendinopathy on the unaffected (or less painful side) which then points that it has overloaded the tendon from
- too much exercise / intense
- too little time / not gradual enough
causing the patient to experience pain.
MRI is also sometimes used,
especially if a full tear (rupture) of the tendon is suspected. Severe
weakness in a tendon is suggestive of a large tear or rupture.
How do our physiotherapists and hand therapists treat a tendon injury?
Tendon treatment varies depending on the type of injury.
- A ruptured
tendon will need review with a specialist to determine the appropriate
course of action. This may include immobilization in a customized splint and/or surgery.
partial tendon tear is often treated conservatively (non-operatively)
initially, and then if the patient is failing to improve, specialist
review and surgical review may be considered.
- Stage 1 includes treatments aimed at controlling
pain (pain relief) and removing or modifying activities that are overloading the tendon. The goal
of stage 1 is to make the patient’s symptoms stable and also to address any weakness or
biomechanical problems that may have contributed to the problem in the
first place. We also focus on educating the patient as to the
cause of their problem and also how to monitor their own progress to
- Stage 2 consists of slow, heavy resistance exercises
that have been shown through research to strengthen the tendon which
improves patient’s tolerance to exercise and activities of daily living.
Stages 3 and 4 consists of increasing the speed and
power of the tendon as well as introducing sport-specific exercises.
Treatment programs are individualized to suit each patient’s needs and
are delivered by a physiotherapist with specific expertise in tendon
Patients should anticipate an 8-12 week program, but for
longstanding tendon problems, it can take 6 months to build up the
appropriate strength due to the level of deconditioning that may be
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Phoenix Rehab Physio Services
Phoenix Rehab Group works with specialist physiotherapists and rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.
PHYSIOTHERAPY & PHYSICAL THERAPY
See all the conditions our principal physiotherapists treat.
HAND THERAPY & CUSTOMIZED SPLINTING
Patients who sustained injuries to their elbows, forearms, hands, wrists
(sprains and fractures) and fingers, usually will benefit / require Hand Therapy to
- manage and decrease hand pains
- improve range of motion, strength and dexterity
- increase the function of their hand
following injuries or post-operations
Commonly treated hand pain injuries includes
REFORMER CLINICAL PILATES & WELLNESS PILATES
Clinical Pilates is a form of physical exercise that focuses on posture, core stability, balance, control, strength, flexibility and breathing.
It is a system of safe and effective exercises, which
meet specific individual needs, to treat a wide range of injuries
You may do Pilates as matwork or with the reformer or both, and every session will be customized 100% to your fitness, injury and tolerance.
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Sports and deep tissue release massage helps to increase nutrient-rich blood
flow to tired, tight and tense muscles to accelerate recovery and shorten downtime / recovery period required.
It also prevents
muscles from scar tissue micro-tears (and potential ruptures), and increases muscle
performance. Having regular deep tissue and sports massage will keep your muscles healthy and fit with body/movement-confidence.
Read the benefits of regular deep tissue release therapy here.
All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB).
See our entire team here with introductions and their specializations.
At the first session, our specialist physiotherapists will carry out a thorough
assessment, helping them to select the most appropriate treatment to
help you recover as well as provide treatment in the same session.
Follow up sessions are inline to provide
expert treatment for your pain as well as prescribing specific
exercises to reduce your risk of re-injury and giving you a long term
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