A tendon attaches muscle to bone. When a tendon is loaded during muscle contractions or as our body interacts with the environment, stored energy is released and the tendon moves from a lengthened position to a shortened position or vice versa.
Tendons can work under heavy loads (lifting weights), fast loads (sprinting) or endurance loads (long distance running).
The function and requirements of each tendon is really important to understand. This understanding will help when it comes to successfully rehabilitating a tendon after an injury.
How do tendon injuries occur?
A normal tendon adapts over time in response to load and as a part of the ageing process. There are plenty of people getting around with tendons that show signs of age-related change including thickened tendons, fluid build-up, fraying, tendon tears, you name it.
These tendons can be completely pain free and you can be functioning perfectly well.
Tendons that are rapidly exposed to load, or pushed beyond their capacity, will start to show small signs of strain and can start to breakdown. If there’s enough time for the tendon tissue to adapt then these ‘changes’ won’t become permanent, its more a reaction to load.
However, if the time for adaptation isn’t adequate, or the load remains too high, we start to see permanent and irreversible changes.
This is called a degenerative tendon. Those tendons that flare-up occasionally then settle, but flare again when the load increases are usually a degenerative tendon reacting to the rapid change in load. We call this ‘reactive on degenerative tendinopathy’.
How do we treat tendon injuries?
As mentioned above, your tendon may be reactive (acutely painful) or it may be a degenerative tendon or a mix of the two. To start a successful rehabilitation program, an accurate diagnosis needs to be made to determine where you sit on the tendon continuum.
Otherwise, you could be further irritating the tendon tissue with inappropriate loading or exercise.
With this tendon injury we aim to reduce pain through controlled, isometric contractions. This type of contraction is useful as it enables us to introduce small amounts of controlled load and has been shown to be effective at reducing pain.
Once the pain has settled the whole muscle-tendon unit needs to be addressed for deficits in strength, endurance and power to ensure that the tissue is able to handle the activity that it’s required to perform.
This type of tendon tissue has undergone irreversible changes, so our aim is to strengthen the remaining healthy tissue.
This process may involve isometric loading if a substantial amount of pain is present and will progress to heavy loading and eventually exercises that are specific for the needs of that tendon.
Rehabilitating a tendon injury can take time. A reactive tendinopathy may settle in a number of days. Degenerative tendinopathies take longer, usually somewhere between 6-8 weeks before you will notice a significant change in pain.
We also know that there are changes that occur in the Central Nervous System (CNS) when tendon pain (all pain for that matter) is present.
This is something that needs to be considered when rehabilitating a tendon injury. This may involve addressing scan results if there is concern about findings, explaining that pain doesn’t always equal damage and that some pain during the rehabilitation process can be beneficial.
A well-rounded, goal driven and measurable program designed between practitioner and patient will ensure a successful return to activity.
At Eastside Physio + Co, we are committed to delivering the best care to the locals of Surrey Hills and its neighbouring areas. Our skilled and experienced surrey hills physios are dedicated to supporting the well-being of our clients, who come from a variety of nearby suburbs, including Ashwood, Ashburton, Auburn, Balwyn, Blackburn, Box Hill, Burwood, Camberwell, Canterbury, Doncaster and Hawthorn.