What Are Tendinopathies?
Tendinopathies comprise a broader category of tendon disorders and differ from tendinitis in terms of their predominant pathophysiological mechanism. Whereas tendinitis is characterised by active inflammation, tendinopathy refers to degenerative changes in tendon tissue that often develop in the absence of clinically evident inflammation.
These conditions are particularly common among middle-aged and older athletes, as well as individuals whose tendons are exposed to chronic repetitive strain.
The Achilles tendon, patellar tendon, rotator cuff tendons of the shoulder and wrist tendons are among the most affected sites.
Symptoms typically include diffuse or localized pain, reduced flexibility and a feeling of stiffness, particularly after prolonged rest or at the beginning of physical activity.
Characteristics of Tendinopathy
The principal pathological change in tendinopathy is the disruption of the tendon’s collagen structure. Instead of the parallel type I collagen fibres found in a healthy tendon, there is disorganized deposition of type III collagen, vascular ingrowth into normally poorly vascularized areas, accumulation of glycosaminoglycans and, in some cases, calcification.
This degenerative process significantly weakens the tendon, increasing the risk of a partial or complete tear, even under relatively minor strain. Early treatment of tendinopathy is therefore important not only for relieving pain but also for preventing more serious tendon injury.
Another characteristic of tendinopathies is their limited response to conventional non-steroidal anti-inflammatory drugs (NSAIDs). This is because the predominant mechanism is degeneration rather than inflammation, making regenerative and biologically based treatment approaches particularly relevant.
Scientific Basis
Contemporary research into tendon pathology has identified degeneration as the predominant underlying mechanism, shifting the focus from anti-inflammatory treatment towards biologically regenerative strategies.
Studies have shown that increasing local oxygen availability can stimulate tenocytes to resume the production of functional type I collagen, thereby improving the mechanical strength and elasticity of the tendon.
Exposure to hyperbaric oxygen appears to act as a biological stimulus that reactivates dormant regenerative mechanisms within the degenerative tendon. This has been demonstrated both histologically, through improvements in collagen fibre morphology, and clinically, through reductions in pain and improvements in function.
The Role of Hyperbaric Oxygen Therapy
In tendinopathies, hyperbaric oxygen therapy may serve as a biologically regenerative adjunct to physiotherapy, eccentric loading exercises and, where clinically indicated, other interventions such as platelet-rich plasma (PRP) therapy or extracorporeal shockwave therapy.
The underlying principle is that a degenerative tendon has a limited capacity for self-repair, partly because of inadequate local oxygenation and vascularisation. Hyperbaric oxygen therapy addresses this deficiency directly. The increased amount of oxygen dissolved in the plasma allows it to diffuse into poorly vascularised areas, activating tenocytes and promoting the production of new, structurally functional collagen.
Hyperbaric oxygen therapy may also activate antioxidant mechanisms, reducing oxidative stress, which is one of the factors that contributes to the persistence of tendon degeneration. At the same time, the resulting neovascularisation may improve the tendon’s vascular network over the longer term and enhance its structural resilience.
Treatment is always tailored to the individual patient, taking into account the location, duration and severity of the degenerative changes. A typical course consists of 20 to 35 sessions incorporated into a comprehensive rehabilitation programme, in close collaboration with a physical and rehabilitation medicine specialist or orthopaedic surgeon.