Treating Tendon Pain Without Surgery

What are Tendons?

Tendons are thick bands of connective tissue, mostly made up of collagen fibers. Their function is to connect muscle to bone, and they are largely responsible for movement. Specifically, the relationship between tendons, muscle, and bone is what allows for bending, walking and jumping. When a muscle contracts, about 70% of the force of the contraction is concentrated in what is called the myotendinous junction, which is where the muscle and the tendon meet. 

This detail is significant because when we use a muscle repetitively in a sport, like the forearm in tennis, the muscle contracts repeatedly, causing a repetitive force to go through the associated tendon. Over time, this can affect the quality of the collagen fibers and connective tissue that make up the tendon.

What is Chronic Tendon Pain?

When repetitive movement stresses a tendon, it can cause degenerative changes to the tissues. Sudden stress from a traumatic injury can also damage a tendon. In either case, scar tissue can form within the tendon, affecting its elasticity. 

When a tendon loses its elasticity, it is much like a rubber band that has become dried out. A new, fresh rubber band has a lot of pliability and rebound, but a dried rubber band feels dry and is very brittle when stretched. Similarly, a tendon becomes brittle from the scar tissue, and small tears within the tendon develop over time.

Overly-stressed tendon tissue results in a combination of inelastic tendon tissue with scar tissue embedded, as well as small microtears in the weakened tissues. Although this describes what is happening on the histological, or tissue’s cellular level, for patients it manifests as pain and loss of function. These specific versions of tendon pain plus tissue change are called tendinosis or tendinopathy. 

Common areas patients will experience chronic tendon pain are:

Diagnosing a tendinopathy that requires treatment starts with the patient’s history and complaints. A physician will evaluate the patient’s history and perform an extensive physical orthopedic exam to determine if their injury is suspect of a tendinopathy, warranting further testing. Then, a physician will usually order an x-ray or MRI, and perform a diagnostic ultrasound to view the tissue. Visualizing the tissue with MRI or ultrasonic imaging is extremely helpful in diagnosing the extent of the problem. It is also important to rule out extensive tendon tearing, which would be a candidate for a different type of procedure, like platelet rich plasma. 

What are Symptoms of and Risk Factors for Chronic Tendon Pain?

How might you know you have tendinopathy? The classic symptoms of chronic tendon pain include the following:

  • Pain that is localized in a muscle attachment 
  • Pain that gets worse with physical activity
  • Redness, swelling, and warmness at the source of pain

Risk factors for tendinopathy are also important to consider, especially because tendinopathy is different from its more acute counterpart, tendonitis. Tendinopathy is distinct in that it includes the scar tissue and microtearing of the tendon fibers, whereas tendonitis is usually inflammation (or tearing) without the chronic tissue change causing tendon damage. 

Risk factors include:

  •  Aging – we naturally lose collagen and elasticity in our tissues over time
  • Repetitive Motions – repeat motions per repeated force through the myotendinous junction, causing stress over time
  • Improper Technique When Performing Activities – improper technique can lead to muscle imbalances and overloading the wrong tissues 
  • Insufficient Tissue Maintenance – When we exercise frequently or play a sport, it is necessary to care for our muscles and tissues with self myofascial release, sports massages, and/or physical therapy maintenance. Not participating in these maintenance activities can lead to chronic tissue damage. 

Tenex: The Non-Surgical Treatment Option

Tenex is a non-surgical procedure designed to specifically target tendinopathies.

An important distinction of the Tenex procedure is that it is always performed under image guidance. The ultrasound-image-guided procedure ensures its specificity in treating the damaged tissue. 

Tenex utilizes an ultrasonic needle that oscillates at a high frequency and has the ability to remove the degenerated scar tissue within the tendon. This procedure is backed by research supporting good results and has a relatively short recovery time.

In a Tenex procedure, the area being treated is numbed to keep the patient as comfortable as possible throughout the procedure. The patient should only feel pressure at the treatment site throughout. The physician will use ultrasound imaging in real time to visualize the location of treatment. 

The Tenex ultrasonic needle is placed through a tiny incision to treat the affected tendon. Then, with continuous ultrasound imaging, the physician uses the needle to break down the unhealthy scar tissue.

This is an outpatient procedure performed in a medical office. The treatment is about 20 minutes long, and the patient is bandaged and sent home the same day of the procedure.

The total anticipated recovery time for the Tenex procedure is four to six weeks. Immediately and in the days after the procedure, a patient may need use over-the-counter medicine like Tylenol to manage any post-procedural soreness, but that would be short-lived. Then, our physicians often recommend physical therapy to help actualize the best results from the treatment. 

Regenexx Tampa Bay’s physicians are committed to helping their patients find the best non-surgical orthopedic options for pain, like tendinopathy. If tennis elbow, achilles tendonitis, plantar fasciitis, or jumper’s knee is holding you back, Tenex is an option worth exploring. 

The Upside? Tenex recovery time is less than a quarter of the recovery time of surgery, so you can get back to doing what you love pain-free sooner. 

About The Author
James Leiber, DO

James Leiber, DO

James Leiber, DO, is founder and medical director of Regenexx® at New Regeneration Orthopedics.
James Leiber, DO

James Leiber, DO

James Leiber, DO, is founder and medical director of Regenexx® at New Regeneration Orthopedics.

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