10 Treatments to Avoid with Tendon Pain

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This episode discusses a 2018 paper by Jill Cook titled: ‘Ten treatments to avoid in patients with lower limb tendon pain’
Listen in to hear what treatments you should and shouldn’t avoid including injections, scans, stretching and exercise.

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Title: Proximal Hamstring Tendinopathy: 10 Treatments to Avoid

Introduction Proximal hamstring tendinopathy (PHT) can be a challenging condition to manage. In this article, we’ll explore the 10 treatments to avoid when dealing with PHT, as recommended by renowned tendon researcher Jill Cook. These insights will help you understand the importance of evidence-based treatments and dispel common misconceptions about PHT.

  1. Don’t Rest Completely One of the common misconceptions about PHT is that complete rest is the solution. However, Jill Cook advises against this approach. Resting too much can actually decrease the tendon’s tolerance and stiffness, both of which are crucial for recovery. Instead, focus on modifying activities that cause pain and gradually reintroduce beneficial loads to the tendon.
  2. Don’t Prescribe Incorrect Exercises Understanding how to load the tendon correctly is essential for effective exercise prescription. High tendon load occurs during activities that require the tendon to act like a spring, such as jumping or sprinting. Slow, heavy exercises involving weights can be beneficial in the early stages of rehab. However, avoid exercises that take the tendon through its full range of motion, as this can compress the tendon at its insertion point.
  3. Don’t Rely on Passive Treatments Passive treatments like electrotherapy and ice may temporarily alleviate pain but do not address the root cause of PHT. They can create a false sense of improvement, only for pain to return when the tendon is loaded. Effective rehabilitation should focus on active, exercise-based treatments that build the tendon’s capacity.
  4. Avoid Injection Therapies Injection therapies, such as corticosteroids or PRP, have been shown to be no more effective than placebos in controlled trials. They do not address the underlying pathology of the tendon and should only be considered if exercise-based programs have failed to produce results.
  5. Don’t Ignore Tendon Pain Pain is a valuable indicator when managing PHT. Pain usually increases 24 hours after excessive loading of the tendon. If you experience an increase of two or more points on a pain scale, it’s crucial to reduce activities that are overloading the tendon. Be aware that overloading often occurs during spring-like movements, such as jumping or running.
  6. Don’t Stretch the Tendon Stretching the tendon is not an effective treatment for PHT. In fact, stretching can add compressive loads to the tendon that hinder healing. While avoiding excessive stretching is advisable, there is a middle ground. Once the tendon starts to feel better, you can gradually reintroduce stretching within your tolerance limits.
  7. Don’t Use Friction Massage Friction massage, such as Graston technique, should not be used directly on the tendon. Massaging or frictioning the tendon can increase pain and does not promote tendon healing. Instead, consider massage on surrounding muscles to alleviate discomfort.
  8. Don’t Use Tendon Images for Diagnosis or Prognosis Using imaging, such as ultrasound or MRI, for diagnosing PHT or predicting outcomes is not reliable. Abnormal tendon images do not always correlate with symptoms, and pathology shown in images remains stable and does not change with pain reduction. Imaging should not be the sole basis for diagnosis or prognosis.

Conclusion Managing proximal hamstring tendinopathy can be a complex journey, but avoiding these 10 treatments will guide you toward more effective and evidence-based solutions. Remember that exercise-based rehabilitation, tailored to your individual needs and pain tolerance, is key to overcoming PHT. Seek guidance from a healthcare professional with expertise in tendinopathy for a personalized treatment plan that works for you.