What is Tendinopathy?


Tendons are tough, cord-like fibres that connect muscle to bone at your joints. They act like the guy ropes of a tent to hold the muscle in place. A tendon injury may seem to happen suddenly, but it is usually the result of many tiny tears to the tendon that have happened over time. Imagine the tendons fraying like rope, but instead of wearing at the edges, the wear occurs within the substance of the rope. This overuse injury of a tendon is called tendinopathy.


In overuse injuries, the tendon is not actually inflamed but can become painful as it is unable to cope with the load that is placed on it. In fact, tendon injuries are usually the result of overuse of the muscle as well as the tendon that anchors it to the bone (the muscle-tendon unit). Although the tendon portion (the guy rope) is injured, there may be weakness or tightness in the muscle that has contributed to this happening. If the muscle is weak and also tight, the tendon may be pulled too taut, or if the muscle is weak and loose, the tendon may have to work harder to tie it down.


The term ‘overuse’ implies that the problem results from too much activity. You have ‘over-used’ the tendon. Put differently, the muscle-tendon unit has to be strong enough to deal with the activity undertaken (the load applied to it), or injury will occur. An overuse injury occurs because the muscle-tendon unit is not strong enough to deal with the load on it.


Load can be:

  1. A sudden huge force, as in lifting heavy luggage.
  2. Smaller repetitive forces, as in starting a walking programme.
  3. Smaller prolonged force, as in staying in one position for a long period of time.


Once the muscle-tendon unit is unable to perform its normal function, further loading makes it harder and harder to heal without help.



Tips for replacing running shoes


Why replace my running shoes?


With wear, all running shoes eventually lose their capacity to prevent potential overuse injuries. To maximise the properties that your trainers offer, you need to ensure that they don’t wear out to the extent that these properties are lost. How quickly this happens is determined by your mileage, body weight and biomechanics.

Running in worn shoes can increase the risk of injury in your lower body and spine.



How can I recognise wear in my running shoes?


  • The sole has worn through to the under layer.
  • The midsole feels too squashy and buckles easily under just a little pressure.
  • The heel becomes bendy and less supportive.
  • Your toes wear through the upper, which may be torn.



What increases the wear of my running shoes?


  • Road running will wear out your shoes quicker than off-road running
  • Higher body weight will wear out shoes quicker than lower body weight.
  • Running on a daily basis will wear shoes out faster than running less frequently.



When should I replace my running shoes?


There is no absolute timescale. How long your shoes last, depends on both you and your weekly mileage. As a general rule, you should replace your running shoes at ~500 miles. However, some people say that wear can be significant at 200 miles. Keep a mileage log to gauge when your shoes may need replacing.



What can I expect from Physiotherapy and Rehabilitation?


  • Your physiotherapy will take a length of time as determined by your progress.


  • An initial period of 3-4 months is the minimum time in which it takes to break ingrained postural habits and start to learn new and healthier body movements.


  • It is recommended that you see a physiotherapist for a home exercise programme and manual therapy as needed.


  • It is a good idea to see your physiotherapist at least once a week for the first month. This will accelerate your learning and provide you with sufficient feedback on how your body is moving.


  • Do see your physiotherapist for ongoing feedback over the next 3-4 months and to evolve your programme as you develop your strength and improve your condition. However, you may be able to increase the interval of time between appointments as your progress allows.


  • You should always feel challenged by a rehabilitation session (it should never be easy!) without aggravating the pain that you are aiming to resolve.


  • Pain in the exercised muscles a couple of days after your workout is good pain, which means that your muscles are adapting to the challenge!


  • If your pain alters in any way, or does not gradually improve, seek a further assessment to ensure that your diagnosis has not changed.