Tendon injuries (known as tendinopathies) can be extremely frustrating to deal with when returning to activity or sport. It’s one of those injuries that seem to linger. Hallmark symptoms of a tendinopathy include pain in the mornings, painful during a warm up, but eases with activity, and then pain returning once you stop the activity.
What is a tendon?
Lets start with what a tendon is. A tendon is a structure that connects the muscle to the bone. It is made up collagen type I, which is a thick, strong fibrous structure. This is in contract to muscle fibre which can is a bit more elastic. The role of the tendon is to transfer force from the muscle contraction, to the bone.
How does a tendon break down?
Tendons break down, when their acitivity is higher than its capacity to take load. For example, if your tendon has a “capacity” of 30 km a week, but you run at 50 km a week, you could be at risk of a tendinopathy.
For that reason, when returning to your activity being mindful of your loads is important. Just because you are pain free does not mean that the tendon is ready to take your normal amount of load or activity. Talk to your physiotherapist about how much of your normal activity you should do. Maybe it means building up your running slowly, or a couple of hours of normal duties at work.
Types of Tendon Injuries
The most common type of tendon injury,is a tendinopathy. This process starts, with the tendon over work (as we mentioned above), which causes the tendon to sustain damage. The tendon will initial try to heal itself, however if it is overworked before it can heal, it will heal poorly, resulting in a weaker tendon. As a result, its capacity is reduced. This cycle repeats itself over and over again, until finally pain begins.
This means, that when you finally do feel the pain, the problem probably started a long time before hand.
The other type of tendon injury, is a rupture. This occurs when the tendon is severed, causing it to retract, and is most commonly seen in the achilles. A huge amount of force is required for this to occur
Tendinopathies are quite common, and most people who do have a tendinopathy recover within a couple of months. They are slow healers, due to the poor blood supply within a tendon.
Exercise is almost always the big part of treatment. The tendon needs stimulus to heal, and exercise when appropriate applied can provide this stimulus. Depending on your level of pain, one of two types of exercises may be prescribed
- Isometrics – An isometric exercise is an exercise where you push and hold against a resistance, for a certain amount of time (normally 30- 45 seconds). Research has shown that this type of exercise can reduce pain
- Eccentrics – An eccentric exercise is an exercise where the muscle is working, while getting longer. For example, the downwards part of a calf raise. This type of exercise has been shown to stimulate the tendon to heal. It is also a lot easier to do than a traditional exercise, and so you can put weight on it quickly
There are also other options as well, including shockwave, taping, and deloading (i.e. reducing the amount of load/exercise) in the short term.
It is important to acknowledge, that tendinopathies are a natural part of aging, and do not always cause pain. There are large parts of the population with various tendinopathies who walk and lift, and do not (and may not ever) have pain. It is important to have a thorough examination prior to treatment, to rule out other structures that may be causing pain.