tendinopathy

To understand the injuries that can occur to tendons of the shoulder, a brief understanding of normal tendon structure is required. A tendon is a tough band off fibrous connective tissue that usually connects muscle to bone.

In response to physical training, the metabolism in tendons changes and as such the tendon will adapt to the greater demands placed on this soft tissue. The tendons exhibit an increase in cross sectional area and tensile strength and there is also an increase in collagen type I synthesis produced by the tenocytes in the extracellular matrix of the tendon.

Inappropriate physical training or repetitive overuse/cumulative trauma can also lead to collagen synthesis. However, in the absence of complete repair to the tendon, it has been proposed that tenocytes react by producing a greater amount of ground substance and type 3 collagen (rather than type 1) in the extracellular matrix of the tendon.

This in turn makes the tendon structure thicker with a greater concentration of nerve and blood vessels (neovascularisation). This pathological cycle can in time lead to degenerative changes in the tendon not only increasing the pain sensitivity of the tendon but also weakening the tendon and making it more susceptible to tears and ruptures.

This cycle of events can occur in any tendon but are particularly common in specific sites such as the rotator cuff tendons, Achilles tendon and the Extensor Carpi Radialis Brevis tendon (tennis elbow).

rotator cuff tendinopathy (supraspinatus)

In the past, clinically, rotator cuff tendinopathies were referred to as “tendinitis” but this has since been replaced by the terms tendinopathy and tendinosis. Although, inflammation may play a role in the initial pathogenesis of a tendinopathy, recent tendon research has uncovered that there is little or no evidence of inflammatory changes in the vast majority of tendon complaints and may explain why anti-inflammatory measures such NSAIDS (neurofen/ibruprofen) and ice have little effect.

The causes of tendinopathies are not fully understood although it has been linked to Impingement syndrome, overuse/trauma, the aging process, gender, weight/waist girth, cardiovascular and metabolic factors

Treatment of rotator cuff tendinopathy (Supraspinatus)

At our City of London based chiropractic and Sports Injuries Clinic, our treatment approach is based on initially reducing the pain and from here the long term goal is focused on improving the mobility of the shoulder and strengthening up the Rotator cuff musculature. Postural exercises are also beneficial to increase the space for the passage of the Supraspinatus tendon and specific scapula stability exercises are also beneficial to improve the biomechanics of the shoulder girdle thus helping to reduce recurrences of this complaint.

If you would like any further advice regarding Supraspinatus tendinopathy, please contact us at the EC2 clinic