«Tendinopathy, commonly known as pain of the tendons, tendinous dysfunctions, which can also last a long period of time, which often impacts in a negative way the working and sporting activity of the person afflicted. Among climbers it is common to find such inconveniences, above all on tendons of the upper limbs, due to their important functional need in climbing.

Tendons are formed by various structures which are able to adapt to the load and are modified depending on the specific movement requirement. If the work load and stimuli are gradual and well balanced, the tendon can “strengthen” itself without excess and thus increase its ability to support the load.

On the contrary, an excess load creates changes at a histological level (the tendon’s tissue), with the consequent onset of the pathology.

Excess load, though, does not seem to be the only factor triggering pain in a tendinopathy. In fact even in a sedentary part of the population it is possible to find a painful symptomology connected to tendinopathy.

Other factors which can contribute to the insurgence of such problems are: an altered function of the muscle-joint coordination, a reduced activity or flexibility of the muscle, an excessive rigidity of the joints, but also intrinsic factors such as a hormonal asset (menopause in women) and being overweight.

Nowadays, for a therapist it is a challenge to manage and treat a tendinopathy due to the difficulty in finding the right load and for the length of the symptoms. The final aim of any curative method undertaken to cure symptoms is to give the tendon and the muscle the adequate loading ability for that specific activity.

Managing such a dysfunction means reducing the pain, a careful selection of exercises needs to be chosen, a strategy of progressive weight load, and above all, an understanding of the problem and the adequate therapeutic path to be undertaken by the athlete

The recovery phases of a tendinopathy can be divided in the following ways:

1) Reduce the pain

During the acute phase the pain is continuous, stable and easy to feel.

The guidelines on treating the pain of tendinopathy do not recommend immobilization and any use of braces. In terms of instrument therapy the use of laser and shock waves is useful.

Stretching must be avoided in the reactive phase of the inflammation, that is, the first days the pain comes out.

Isometric exercise instead seems to have an important analgesic effect. Literature recommends to maintain contractions for 50-60 seconds for 4-5 times, repeating this various times throughout the day. Exercises in this phase must not be painful and above all must not increase the pain when resting.

2) The loading phase

Once the irritative, acute phase (first weeks) is over, it is necessary to introduce the load once again. The successive phases deal with the increase in the tendon’s ability to withhold the load, through simple non specific exercises, and then specific and functional exercises for climbing. The progressive loading, in fact, seems to be the most efficient strategy to gain positive results.

In this phase it is also important to work on the pain. In fact, often, it happens that due to the pain, one stops doing that kind of movement or stops activity completely. This strategy of elusion does not allow the tissue to remodel itself correctly and does not allow to increase the ability to take on weight, causing the pain to become chronic.

So, how and when to start loading our tendon?

Literature agrees that a programme of exercises should last on average 3 months, but that it can be extended to 6-12 months to reach a total remission of the symptoms. Exercise seems to be the main source of treatment. The type of exercise is variable. Excentric exercises are what collect most  consensus, but a combined amount of loading seems to be best.

The amount of loading, instead, should be based on the symptomatology and to the reaction to pain. A good load should cause pain which does not go over 4 out of 10 on a scale of 0-10, but at the end of the exercise the symptom must completely disappear, or must not last throughout the following hours. The tendon must be loaded on alternate days, always aiming for a rest day.

As well as the exercises which require specific loading, it is necessary to deal with other factors which can contribute to the development of tendinopathy.

It is therefore important to keep a few aspects into consideration.

• Respect and correctly treat the acute and reactive phase;
• Do not necessarily consider the pain which occurs weeks from the acute event, dangerous for the tissue, but imagine that it is not well adapted to the central nervous system;
• The gradual load does not only have a structural effect on the tissue, but also a neuro-cognitive effect.

It is important that when muscular-skeletal pain presents itself to find a competent professional therapist who understands the problem and consequently follow an adequate therapeutic course which will be followed actively by the patient».

Article by Silvio Reffo