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Tendons – What is it?

theinjuryrehabcentre Nov 01, 2018

Tendon injuries which are commonly referred to as ‘Tendinopathies’ are highly prevalent through society and athletic populations. Within the body any tendon can become painful, with the most common sites being in the lower limb (either Achilles or patella) due to the forces exerted from high impact activities such as running, jumping and landing. We also Tendinopathies through the upper extremity, throwing athletes (cricket, baseball) or racquet sport athletes  suffering from tennis/golfers elbow (forearm muscles) or Rotator cuff Tendinopathies (most likely the supraspinatus). There are a few clear reasons why tendons become injured, they are;

  • An excessive amount of load in a short period of time (playing a new sport/ spending a whole day using a hammer).  During this period our body doesn’t have enough recovery time to allow the muscle/tendon to adapt to the load so it breaks down (we see pain and inflammation).
  • A period of de-load (rest) then resuming activities (taking a holiday for a few weeks then resuming basketball 4 nights per week). Tendons and muscles love to undergo load, too much and it can lead to injury but also too little means that the tendon doesn’t have enough load so it begins to become stiffer which means it cannot absorb load as well as it once did.
  • Repetitive micro-trauma over a long period of time. This is an overuse injury where we don’t give our body adequate time to recover from the stress that it takes on. Seeing as though it is never fully recovering it gradually gets worse and worse over time.

The treatment and management of Tendinopathies is one of the most challenging aspects we face in sports medicine. Every few months there is a new report on what is best for certain Tendinopathies; whether that is surgery, medications, injections or exercise interventions.

The role of a tendon –

The role performed by the tendon is crucial to our musculoskeletal system, the most basic and accurate way to describe what they do is that they transfer force from our muscles to our bone. The force which the tendon controls has 2 components; intrinsic (the individual contracting the muscle – moving) and extrinsic (ground reaction force).

 

When we get force applied to the tendon we see the first phase where the tendon stretches (this builds elastic energy) the energy created then transfers the force to the attachment site (which in most cases is bone). The stiffness of the tendon determines how much force is transferred; to stiff the tendon transfer the force to the bone (usually results in a stress response), not stiff enough and the force goes into the muscle (which may lead to soft tissue injury.

 

Risk Factors for Tendinopathies –

We have 2 categories to assess risk factors for these injuries:

Extrinsic -

  • Rapid increase in training volume/load/intensity
  • Change in footwear
  • Occupation

Intrinsic -

  • Age - older we see tendon degradation, younger we see issues with the insertion pulling on the bone.
  • Body weight - a higher body mass increases stress through tendon.
  • Biomechanics - Landing/jumping off forefoot increase load through patella tendon or having a slice serve in tennis compresses the rotator cuff tendons in the shoulder.  

Managing Tendinopathies –

In most cases we often see pain as well as loss of function with these activities, so we need to incorporate multiple strategies to address all the factors that may be causing the issues. We first start with identifying the risk factors and then modifying them accordingly. From the research we know that;

  • Increasing muscle size can have a sparring affect on the tendon (achieved through resistance training).
  • Heavy load resistance training is recommended to improve tendon function
  • Isometric exercises have been shown to improve the structure of the tendon

At the Injury Rehab Centre we evaluate the individual on a case by case basis and work out what will help the individual the most in the short term and long term.  

Case study -

An example of this a patient of mine that had Achilles tendinopathy; the individual had recently increased his running from 10km per week to 35km (preparing for a marathon) and had recently bought new footwear. Straight up we can see there is a dramatic increase in workload being performed but also he had bought a new pair of shoes that didn’t suit his feet (which affected biomechanics). Once we decreased the risk factors causing the painful state and we saw a return to function, we conducted a Super-Session at the clinic which identified that the individual had reduced ankle range of motion on the injured side (risk factor for lower limb injuries) but also found that they had a decreased strength (could only manage to perform 3 reps at 1.2 x Body weight) and with runners we see roughly 1.5 x body weight going through each leg with each foot strike, so if they don’t have the strength something else needs to take up the slack (which can be the tendon at times).  

We manage the individual by reducing the risk factors (as much as possible – some cannot be avoided i.e genetics), but then provide them with enough load so that the tendon can regenerate and get stronger, but also so that they can get stronger so that the tendon doesn’t break down again.  

Why the Injury Rehab Centre can help?

At the Injury Rehab Centre we specialise in assessment and collecting actionable data using the latest technology previously only found in elite sporting institutions particularly in understanding how and why injuries occur. This includes:

  • M.A.T Assessment created by the therapists of the Injury Rehab Centre to laser focus on areas of flexibility, balance and movement that identify the risk factors of injuries.
  • Traditional Physiotherapy and Osteopathy examinations to the lower back as well as hips as well as other regions of the body.
  • Strength Testing to identify any strength discrepancies that may be causing your injury or pain.

Next our treatment process achieves pain relief in the shortest amount of time by using hands on Physiotherapy and Osteopathy techniques such as soft tissue massage, joint manipulation, articulation and stretching techniques. This may include the use of the True Stretch system as well as Dry Needling and Taping techniques.

Finally your management plan will involve an individualised training plan to build your strength and capacity (muscle and tendon strength, stamina, specific flexibility) often to improve discrepancies from side to side that could be the true cause of your injury.

For any help in regards to any injuries you may be suffering from yourself or you have any questions relating to any other injuries feel free to call The Injury Rehab Centre on (03)9553 7024 or email [email protected]

References –

  1. Magnussen, R. A., Dunn, W. R., & Thomson, A. B. (2009). Nonoperative Treatment of Midportion Achilles Tendinopathy: A Systematic Review. Clinical Journal of Sport Medicine,19(1), 54-64.
  2. Kjær, M. (2004). Role of Extracellular Matrix in Adaptation of Tendon and Skeletal Muscle to Mechanical Loading. Physiological Reviews, 84(2), 649-698.
  3. Frye, A. C. (2009). Bone density, geometry, strength, and muscle size in male runners with and without a history of stress fracture.

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