The Fundamentals
Tendons connect muscles to bones, ensuring joint movement throughout the body. If a tendon is older/overused, it can sometimes be more prone to degeneration following repetitive injuries. It is now known that tendon injuries thrive on rehabilitation as pervious medical and surgical procedures often fail to regain full tendon function. This, in turn, inhibits an individual’s basic lifestyle.
The Terminology
For years words such as tendinitis, tear, tendinopathy, rupture and tendinosis have been frequently used. Although these terms are not incorrect nor inappropriate, where and how they are utilised leaves room for question.
‘Tendinitis’ suggests an inflammatory condition of the tendon. However, in 1976 it was determined that a symptomatic Achilles tendon (achilles tendon experiencing pain) was without the presence of inflammatory cells, thus changing the outlook of ‘tendinitis’. This means that while inflammation is a feature of tendon pathology, it is not the sole influence of tendon pain.
The suffix ‘itis’ in tendinitis suggests treatment at the first opportunity in necessary, which has been shown to have limited effectiveness. This narrative has opened the doors to researchers trying to determine what tendon pain really is.
‘Tendinopathy’ is now the preferred word throughout the clinical settings.
Common types of tendon injuries
Upper body
- Rotator cuff (cricket players, rounders players & squash players)
- Forearm extensors (tennis players, golfers & cricket players)
Lower body
- Achilles tendon (track and field athletes, runners & tennis players)
- Tibilais posterior
- Patella tendon (footballers, running, basketball players & high/triple jump athletes)
How are tendon injuries sustained?
When a tendon is subject to an unusual or high load it is at risk of injury. Tendon injuries account for a substantial proportion of overuse injuries in both competitive and recreational sports participation as well as jobs that require repetitive activity. Tendon pain serves to protect the area- this being a defining characteristic of pain.
However, the relationship between pain and evidence of tissue disruption is variable amongst individuals. It is possible to experience tendon pain in ‘apparent’ normal tendons. Therefore, defining how tendon injuries/pain are attained is still proving difficult for research.
Actue:Chronic Workload Ration
Adequate training is essential for task specific stimuli to minimise the risk of under/overtraining. Research is forever developing, and it is now thought that training itself does not solely cause injury and that in fact inadequate and inappropriate prescribed training can lead to injury as well. Excessive and rapid increases in training, whether that be volume/frequency/load can lead to the highest rate of injury. In addition, undertraining can have a detrimental effect on the body, where exposure to external factors allow for inexperience and training troughs to form which, in turn, can contribute to injury.
What to expect with tendon pain…
Increasing pain at the site of the tendon which usually coincides with an increase in activity. Sometimes, during early stages of tendon pain, pain is present at the start of the activity and the cooling down period. Sharp, severe, dull ache are the common words used by people describing their symptoms.
Do’s & Don’t’s!
DO LOAD! Initially, start at a level where the tendon can tolerate. This can be done using weight as the changing factor or progressing/regressing exercises. Working eccentrically (slow lengthening under load) aids rehabilitation. Get in touch to know more about this!
DON’T REST COMPLETELY
- This will decrease the tendons ability to accept load.
DON’T ALLOW FOR PASSIVE NICE TREATMENT
- Treatment needs to encourage a load for long term benefits.
DON’T IGNORE PAIN
- Pain means the load is too much, reduce elements of your training that are overloading the tendon
DON’T STRETCH A DAMAGED TENDON
If you have any questions regarding tendons or are experiencing tendon pain then please do not hesitate to get in touch via the website; www.injuryrecoverycentre.co.uk or via email; olivia@injuryrecoverycentre.co.uk
Liv
BSc Hons Sports Therapy MSST
MSc Strength and Conditioning
REFERENCES
Bourdon, P.C, Cardinale, M, Murray, A, Gastin, P, Kellmann, M, Varley, M. C, Gabbett, T. J, Coutts, A. J, Burgess, D. J, Gregson, W and Cable, N. T (2017) ‘Monitoring Athlete Training Loads: Consensus Statement’, International Journal of Sports Physiology and Performance, (2)12, 161.
Cook, J. L (2019) ‘The Tyranny of Tendon Terminology’, La Trobe University.
Cook, J. L (2018) ‘Ten Treatments to avoid in patients with lower limb tendon pain’, British Journal of Sports Medicine, 52(14), 1-2.
Cook, J. L, Rio, E, Purdam, C. R and Docking, S. I (2016), ‘Revisiting the continuum, model of tendon pathology: what is its merit in clinical practise and research?’, British Journal of Sports Medicine, 50(19), 1-7.
Khan, K and Cook J (2003), ‘The painful non-ruptured tendon: clinical aspects’, Clinical Sports Medicine, 22(1), 711-725.
Rudavsky, A and Cook, J. (2014) ‘Physiotherapy management for patellar tendinopathy (jumper’s knee)’, Journal of Physiotherapy, 60(3), 122-129.
Wu, F, Nerlich, M and Docheva, D. (2017), ‘Tendon Injuries: Basic Science and New Repair Proposals’, Effort Open Reviews, 2(7), 332-342.
