Tendon pain and management

Tendon injuries, commonly know today as tendinopathy, are a common presentation in the clinic. They can occur throughout the lifespan and are commonly associated with repetitive sports, high load sports, trauma and in the older population can occur due to age-related changes in the tendon physiology. Commonly injured tendons include the achilles tendon, gluteal tendons, wrist & elbow tendons, shoulder tendons and knee tendons.

TENDONS AND INJURIES

Tendons are the part between the muscle belly and the bone to which the muscle attaches (the white part in the picture below). Their main function is to store and release energy, much like a spring. They are incredibly strong, and even stronger than the muscle and bone itself.

Tendon pain and injuries are very common presentations in the clinic and tends to appear for one of two reasons:

1.     Frequently performing very repetitive movements (chronic) – tendinosis – usually no inflammation present.

2.     Loading the tendon in a way it cannot handle, causing a rupture or tear (acute) – tendonitis – inflammation is present.

SOME SIGNS THAT MY PAIN COULD BE FROM A TENDON:

-        Delayed pain after exercise, usually the following morning, but can be up to 24 hours.

-        Pain increases as load increases.

-        Pain does not linger once the load is removed.

-        No pain without load/at rest.

-        Pain disappears after warming up but will return post-cool down.

-        Localised pain without referral.

HOW DO WE MANAGE THIS?

In most types of injuries, such as sprains and strains, we have inflammation present (as is the case with an acute tear due to overloading and tearing or rupture of the tendon. This is something we want to settle down first, which will help decrease pain and increase movement. We then want to commence slowly load the tendon area as tolerated and gradually build from there. If the tendon injury is chronic however, our approach is to load the tendon straight away - chronic tendon injuries don’t respond well to rest, they need to move and be loaded up and physically stressed gradually to heal.

If we look at the structure of a tendon there are many fibres that run parallel to each other; this is why they are so strong. The goal of our rehabilitation is to maintain load and tension through these fibres to ensure they continue functioning in this way. If we just rested the tendon then these strong parallel fibres can become ‘disorganised’ where the fibres start to change shape and no longer sit in tight parallel lines and this decreases the strength and capacity of the tendon to do the work you need it to.

The first step is to manage the tendon pain is done by adjusting one or more of the following variables to your painful movements or tasks:

-        Decrease the speed.

-        Decrease the frequency.

-        Decrease the volume (e.g., repetitions, sets, etc.).

-        Decrease the intensity.

We can also mange the tendon pain using isometric exercises which involves contracting the target muscle and tendon without changing the length of that muscle. E.g., performing a wall sit or a plank.

Once the pain has settled and isometric exercises are well tolerated, we will then gradually increase the training, starting with strength training. This stage involves strengthening the target muscle and the kinetic chain (i.e., the limb), and work on functional strength that is specific to your desired task/movement, and building muscle and tendon endurance.

Once able, we will progress the training to adding energy storage loads, where we work on the spring-like function of the tendon using speed and eccentric exercises. An eccentric exercise involves loading the muscle and tendon as the fibres get longer. E.g., loading the your chest muscles with the down phase of a push up or your hamstrings with the down phase of a squat.

The last step to our management is working on the energy storage and release which involves sport specific loading and utilising fast, explosive movements to make sure the tendon and individual is ready to handle the movement or task that caused the issue in the first place.

Whist you are working through this program, it is also important we improve the function of the area as much as possible. We need to make sure not only the affected area, but also surrounding, supporting joints and muscles are doing their job and functioning well. This something we can target with our hands-on treatment at the clinic.

IS THERE ANYTHING ELSE I CAN TRY?

There are many studies looking at different ways to manage tendon injuries, and almost all the evidence points towards correct loading of the tendon like what I have just discussed. Studies have covered other common interventions such as medications, corticosteroid injections, surgery, and platelet-rich plasma (PRP) injections, all of which didn’t have the short- and long-term results of a loading program. Persistent and chronic tendon injuries may respond very well to treatment with Shockwave Therapy. Here at Eureka Health we have a state of the art Shockwave device. This particular device has good evidence to support it’s use in chronic tendon injuries.

MANAGING TENDON PAIN IN ATHLETES:

Tendon pain can cause big issues for an athlete due to the pain affecting the function of the joint and thus performance. If the tendon is painful it will prevent the spring-like behaviour of tendon, and then stop athletes from fast, explosive movements, which are so important in many sports.

Having a tendon injury mid-season is difficult to rehabilitate properly, so our goal becomes controlling pain and maintaining performance levels. We aim to achieve this by managing the load to the tendon, decreasing aggravating loads if possible, using medication, and most importantly, monitoring to make sure it doesn’t get worse.

A full recovery during the season is typically unrealistic because the constant aggravating loads of competition will slow down the healing and rehabilitation. But if we can manage the pain as much as possible, we can buy some time to properly rehabilitate the tendon after the season ends

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If you are experiencing pain from repetitive movements or an increased load, come in to Eureka Health and have one of our experienced practitioners assess your injury, find the cause of your pain and make sure you have the right management to get back to doing what you love doing painfree again.