Tendons are those flexible cords of collagen tissue that attach muscles to bones and thereby move the parts of our body. They protect against the muscles from damage by absorbing external forces. When there is excessive load on tendons, for example during vigorous physical training such as sprinting or high jumping, damage and degeneration occurs as a result, AKA tendinopathy which will take you down the road of pain, swelling and impaired performance.
If you are wondering how someone is likely to get tendinopathy, there are several risk factors that could lead to this painful condition such as:
- Repetitive movements (i.e. jumping rope)
- Overstretching or repetitive stretching
- Quick directional changes (i.e. tennis, rugby, football)
- Poor technique (landing wrong from a jump),
- Muscle imbalance
- Improper joint alignment (i.e. foot pronation, hip rotation)
- Sudden forceful muscle contraction (i.e. high kick of ball, sudden jump)
All of the above factors can cause changes in tendon which if persisted can lead to tendinopathy; and the tendons commonly involved are Patellar tendon (knee), Achilles tendon (ankle), Hamstring tendon (hip). Now to discuss the important part of dealing with a tendon problem, this is what you should keep in mind:
- Complete rest is not the solution
- Don’t ignore your pain. Pain management is important as pain can limit activity and function.
- Load Tolerance: start with easy light isometrics exercises (such as static heel raises, static wall squats), then progress to eccentric/lengthening exercises (such as heel drop or single leg slides) and then progress to energy storage (such plyometric or explosive movements like jump/land or balance exercises).
- Functional activities. Always integrate functional exercises to develop and strengthen the body and joints in all movement patterns to allow you to continue your activities of interest.
- Don’t rely on passive treatments. Exercise-based treatment is more effective than using treatment modalities such as ultrasound, TENS, or stretching alone because increasing tendon tolerance (by loading it through exercise) is what is needed for it to heal and recover.
- Don’t rush rehabilitation.
- Don’t use friction massage directly on tendon. Instead, release tissues around it like muscles, fascia, nerve mobilizations, dry needling and stimulation around the tendon.
- Find out what caused or led to the person to develop a problem in the tendon in the first place and start by correcting it before allowing them to return to training or sports participation.
Bottom line, the key factor in managing tendinopathy is: TISSUE WILL RESHAPE AND MOLD DUE TO STRESS APPLIED. Apply the correct rehabilitation stress and the tissue will regenerate and allow for full functional recovery.