Understanding and Diagnosing Tendinopathy

This article is an excerpt is from Sports Medicine Acupuncture: An Integrated Approach Combining Sports Medicine and Traditional Chinese Medicine by Matt Callison.

A tendon is considered part of the contractile muscular unit. Although the tendon does not contract on its own, it can be placed under stress by the muscle that attaches to it. Tendinopathy is defined as any injury condition that occurs to the tendon itself, its surrounding synovial sheath or its insertional attachment to the bone.

There are many different terms used in sports medicine textbooks for tendon pathologies. Here is the catego­rization of different tendinopathies used in this textbook:

Tendinopathies are usually the result of overuse. Repet­itive activities and cumulative microtraumas can stress and weaken the tendon and its surrounding tissue. Tendon injuries will often occur in regions of poor blood supply, such as 0.5-1 inch from the insertion site of the supraspinatus tendon onto the humerus and at 1-2 inches proximal to the insertion site of the Achilles tendon onto the calcaneus.

Tenosynovitis, which some clinicians call paratenonitis, is an inflammatory condi­tion of the paratenon or synovial sheath that surrounds the tendon. Although this tissue covers the length of the tendon, the areas of injury and inflammation are usually isolated to small regions in the synovial sheath. The practitioner can confirm the presence of an active in­flammatory process by palpating the tissue for warmth.

It is important to note that acute inflammation is usual­ly confined to the tissues that surround the tendon and inflammation of the actual tendon fibers is rare; this is one reason that the term “tendinitis” is falling out of favor in sports medicine and orthopedic circles.

Chronic tendinopathies are frequently labeled as tendi­nitis or tenosynovitis, but an increasing body of evi­dence supports the idea that chronic tendon conditions do not commonly involve inflammation and, therefore, it would be more appropriate to categorize many of these injuries as a tendinosis.

A review of surgical cases demonstrated that an inflammatory process was not evident in cases diagnosed as tendinitis. In fact, fibro­blast cells far out numbered inflammatory cells in all of the surgical cases. Other research has shown that in most cases of tendinosis, tissue adaptation and collagen degradation is found in the absence of inflammatory cells. This is a major reason why tendon injuries respond so well to heat applications, such as moxibustion, warming liniments, TDP lamp and/or hydrocollator packs.

Diagnosing Tendinopathy

The diagnosis of tendinopathy requires an assessment of function along with palpation in order to determine the exact area of the soft tissue lesion. An accurate diagnosis should not be based on palpation alone. It is necessary to challenge the function of the involved tissue in order to correctly identify tendinopathy.

For example, the functional test for patellar tendinopathy is resistive quadriceps testing, which will elicit pain in the tendon. The practitioner then palpates the exact location on the patellar tendon to confirm the site of pain.

To accurately diagnose tendinopathy, the practi­tioner must assess the patient for:

• Probable pain with resisted muscle testing of the involved tendon.
• Possible pain on passive stretching of the muscle of the involved tendon.
• Pain when palpating the tendon in a cross fiber direction.
• Pain with activities involving the tendon.

When palpating the painful tendon, the TCM practitioner will need to assess for excess and deficient conditions, as well as hot and cold conditions, as this will help determine treatment strategies.

The common denominators with most cases of  tendinosis are the lack of inflammatory cells, a decreased blood supply and decreased oxygen. The TCM practitioner frequently sees these conditions and they often present as a condition of cold stagnation. This helps to explain why chronic tendon injuries consistently respond well to acupuncture and moxibustion treatment.

Treating Tendinopathy with Acupuncture

If you’re suffering from tendinopathy, consider acupuncture as a treatment option. You’ll want to ensure that you consult with a qualified sports acupuncturist who specializes in sports injury therapy. Our C.SMA practitioners are school in Western medical approaches as well, enabling them to work together with your healthcare team. With the help of a well-rounded team, you can develop a personalized treatment plan to get you back on track to an active and pain-free life.

If you’re an acupuncturist or enrolled in an acupuncture program who is interested in expanding your education to include common sports injuries like tendinopathy, check out our Sports Medicine Acupuncture Certification Program. With more than 250 hours of advanced training, it is the most advanced training available to acupuncturists who want to excel at understanding and treating sports and orthopedic injuries.