Tendon injuries: What are they and how do they happen?
Tendons are the structures that connect muscles to bones. Pain and pathology in a tendon, known as tendinopathy, is a common injury in athletes that can prove quite difficult to manage. A tendon becomes tendinopathic when it is subject to higher loads than it can withstand, upon which the tendon starts to change in structure resulting in pain and disability.
Tendons don’t like rapid change. A change in loading, whether that be an increase or decrease, may result in tendon pathology.
The loads that can lead to tendinopathy are:
Compressive loads where the tendon is compressed against the bone
Tensile loads where the tendon is loaded in a lengthened state
A combination of tensile and compressive loads, for example stretching where the tendon is both lengthened and compressed against the bone
Shearing loads, which cause a friction of a tendon within the tendon sheath (this only occurs in certain tendons)
Once a tendinopathy has occurred, a staged rehabilitation program should be commenced. There is no “quick fix” for a tendinopathy and, in fact, injections such as cortisone have been found to cause more damage to the tendon long term.
The tendon rehabilitation process should be staged as follows:
Stage 1: this phase focuses on reducing pain by reducing the adverse loads on a tendon. Stretching should be ceased, as well as any other aggravating activities causing pain. Isometric (sustained holds) exercises are commenced to assist in providing pain relief
Stage 2: this phase focuses on strengthening the tendon/muscle, while still avoiding adverse loads. Strengthening exercises should be performed slowly with reasonably heavy loads.
Stage 3: this phase focuses on exercises aimed at power development increased the energy storage capacity of the tendon, i.e. the ability to absorb load. These are generally higher speed exercises such as skipping and jumping.
Stage 4: this phase focuses on sports-specific requirements of the tendon and the elastic function of the tendon (i.e. the ability to work in a lengthened position).
One of the failures of a tendon rehabilitation program is not progressing through each of these stages of rehab. If a rehabilitation sage is progressed too early, the process will not work. Conversely, if the program is not progressed beyond stage 2, it will also not work. It is important to consult a practitioner that has an understanding of tendon loading, the rehabilitation process and the progressions required to completely recover from a tendinopathy.
At Melbourne Sports Physiotherapy, we have vast experience treating all sorts of tendinopathy and tendon injuries. All out our tendon physiotherapists keep up to date with all the latest research evidence on treating tendon, helping you feel better faster in the most efficient way possible.