Tendiniopathy is one of the most common sources of acute and chronic pain affecting the general population of all ages as well as the sporting elite.

Tendinopathy, sometimes called tendinosis, or by the outdated term tendinitis, is an abnormal structure within a muscle and/or tendon. It is most often caused by muscle overuse, although it can result from underuse, because healthy muscle/tendon structure depends on being cyclically loaded within a certain range- so too much or too little loading can lead to abnormal tissue structure.

Overuse tendinopathy is characterised by a build-up of tendon material, mostly collagen, which forms nodules or lumps within the muscle and/or tendon. These are commonly referred to as "knots". Due to in-growth of different types of sensory nerves and the production of a cocktail of "pain" chemicals within the formations, tendinopathy can be a source of a wide variety of symptoms. These include intense sharp shooting, burning and gnawing pain, dull ache, stiffness, as well as tingling and numbness.

Normally, muscle and tendon are highly organised structures. Collagen fibers are more or less aligned along the direction of the muscle with a scattering of tendon building cells, called fibroblasts (cells gaining infamous notoriety). When affected tissue specimens are viewed under a microscope, there appears an abundance of hyperactive fibroblasts overproducing highly irregular swirling masses of fragmented collagen fibres. You'd see splits and gaps where it should be solid. Such tissue is barely equipped to carry out one of its important functions which is to transmit muscle generated forces to your bone. These changes also make the affected tissue more vulnerable to strain, tear or rupture.

Tendinopathy most often affects the ends of a muscle, where all the forces generated by each muscle cell converges onto your bone. The build-up of collagen can surround a joint, binding it like cement, preventing normal painfree movement. Because many tendons attach very close to a joint the pain can feel like "joint" pain. In fact, studies have shown that tendinopathy often precedes joint derangement such as occurs in osteo-arthritis.

Osteopathic treatment may help relieve tendinopathy by : remodelling tissue architecture; stimulating tissue regeneration; and by improving blood supply and nerve activity so the tissues can heal unimpeded.

To achieve long term resolution it is important to identify and manage underlying causative and maintaining factors.