Painful tendons can get in the way of sports and hobbies. Sometimes they can linger for months or even years. In this article we will go over the two main types of tendon pain and most importantly – what to do about it!
First, let’s briefly discuss what a tendon is:
Tendons are made up of connective tissue and they attach muscles to bone. They transfer forces from the muscular system to the skeletal system which allows us to move. Tendons also share a huge role in energy storage and release.
Picture your Achilles tendon during a run. With each foot strike the Achilles absorbs energy and then releases it when the foot leaves the ground for another stride. Healthy tendons are pretty incredible but they can be a huge drag when they’re not.
Tendons are typically injured when they are asked to do a task that is above their current capacity. In other words, when we “over do it” our tendons are often the ones who will suffer.
I personally saw A TON of tendon injuries coming off of the Covid pandemic. After taking a break from running, weight lifting, pickle-balling, etc there needs to be a gradual increase back to activity – no going from 0 to 100!
Tendons can be injured from a single isolated event (lifting something that was too heavy) or from overuse (playing golf 7 days a week when you used to play twice). But with either case it’s an issue of putting too much stress on our tendons.
Most of us have heard of tendonitis. But what about Tendinosis?
Tendinitis has the suffix -itis meaning there is an inflammatory process occurring. Tendonitis is used to describe acute injury. There is pain and sometimes swelling or redness over the affected area.
On the other hand, the suffix -osis is used to describe degeneration. Tendinosis is a chronically painful tendon that is no longer in an inflammatory state. At this point, the connective tissue of the tendon is beginning to experience changes within the collagen fibers. A tendinosis is simply a tendonitis that has gone on for too long.
Tendon degeneration sounds scary right? What’s going on??
In healthy tendons, their connective tissue is made up of type 1 collagen fibers which run parallel to each other. This is seen in figure B. When a tendon has begun a degenerative process the collagen fibers convert from type 1 to type 3. Type 3 fibers are depicted in figure A.
They lose their parallel orientation and become weakened. The good news is that with proper loading of a degenerative tendon it can remodel back to the stronger type 1 fiber type. It just needs some high quality physical therapy which is the gold standard for treatment!
Treatment for the most common tendon pain: tendonitis
Since we’ve established tendonitis is an inflammatory response, treatment aims to reduce further inflammation. The most important thing is to reduce the load placed on the painful tendon. This can be done by modifying your activity level and I like to call this phase active rest. For example, if you’re dealing with rotator cuff tendonitis – lay off golf or pickleball but still walk or bike. If you’re dealing with Achilles tendonitis – skip your runs for a few weeks but try getting some laps in at the pool instead.
Tendons have poor blood supply so if you can stay moving this will help facilitate the healing process. Diet is also huge for inflammation. Let’s avoid fast food and instead focus on foods that fight inflammation such as tomatoes, spinach, and salmon.
Lastly, there has been a shift in the research regarding ice and anti-inflammatory medications for acute injuries. This topic is beyond the scope of this article but stay tuned for more on that to come!
Treatment for tendinosis
Most of the tendons I treat with physical therapy are in the tendinosis category. These tendons have begun a degenerative process and need to be loaded appropriately to adapt and heal.
Loading of a tendon promotes tissue remodeling and will increase the resiliency of the tendon. This process will depend greatly on the individual, but in general will start with isometrics, progress to eccentrics, and finish with plyometrics. Hands-on therapies such as dry needling and soft tissue mobilization also aid in recovery.
The bigger picture of tendon pain
Overuse injuries often occur due to underlying biomechanical issues. Repetitive movements such as running or swinging a racket can put a lot of stress on our tendons.
It’s important to have your whole movement system examined to determine what muscles may be weak or tight that contributed to the development of tendon pain. Here at Alpine Fit we don’t just fix the painful area, we find the long term solution.
Below are examples of exercises that may be included in tendon rehabilitation:
Rebound Heel Raises
Eccentric Heel Raise Exercise
Wrist Extension Isometric
Wrist Extension Eccentric
If you’re curious about more ways to prevent injury, talking with a Doctor of Physical Therapy is a great place to start.
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