The Tribulations of Tendons
Running season is nearly upon us. Unfortunately for many people this means that it's also the start of injury season.
One of the most common types of injuries we see as physiotherapists are those of the pesky tendon. The most common cases are those in the population who have either just started running for the first time, or those who have recently increased their frequency or intensity of exercise. However, often tendon injuries can seem to come on without an obvious cause at all, and it has been shown in studies that often people can have a clinically shoddy tendon, without any pain at all. Tendon injures can become exceptionally painful, and in the worst cases can even lead to rupture.
Common places to get tendon injuries are the elbows, (tennis elbow -or the fancy term lateral epicondylopathy), the Achilles (the large tendon at the back of the heel), the shoulder (in a group of muscles called your rotator cuff, and the sole of the foot (Plantar fascia), but you can get tendinopathies just about anywhere a muscle attaches to a bony part of the body, especially if it is an area which is being repetitively loaded.
The way tendon pain usually develops is when a person is using the joint over and above the rate that the tendon is able to heal. When this happens, micro-tears appear in the tendon and your body quickly reacts by increasing the amount of repair cells pumped into the tendon. Unfortunately these repair cells are not designed to take tension like the collagen fibers that make up a healthy tendon. This often leads to a worsening problem as the repair cells weaken the structure and it begins to wear more quickly. If the activity that is causing these negative changes is not stopped, the tendon has the potential to get weaker and weaker. This change in a tendon is called a tendinopathy.
Often people are offered the quick pain reliever of a corticosteroid injection into the problem area by their GP's, However this is becoming increasingly frowned upon within the musculoskeletal world due to the long-term repercussions of this 'quick-fix' thinking. Corticosteroid injections will often remove the symptom of pain in a painful tendon, however the underlying process mentioned above will not be stopped with such treatments. Pain is (in most cases) an unpleasant symptom because our body is trying to show something is not happy. If you eliminate this signal from the affected area, often you may become oblivious to the underlying pathology that is giving pain in the first place. Without the pain, you may be lured into a false sense of security and begin overloading the tendon. If this happens, once the injection wears off, more often than not the pain you had will come back with a vengeance. Identifying tendon injuries early before they become so painful we feel we need for these injection is by far the best strategy of management. You should always try at least 6 months of conservative physiotherapy and exercise management before exploring more invasive procedures. It is the only long term solution to tendinopathic pain.
Physiotherapists and Personal Trainers should always be aware of the early warning signs for tendon injuries, and if these are spotted in the early stages, and treated with exercise before they worsen then often you can save a great deal of grief in the long run. Progressive loading of the tendon to encourage the laying down of stronger collagen fibers designed for tensile loads will give a long term solution to these problems.
If you experience point tenderness where a muscle attaches into a bone, pain on movements at a specific site, or even a discomfort on certain joint movements it is advisable to speak to a physiotherapist in the early stages. Physiotherapists can test for specific tendon injuries and usually give you the advice and rehabilitation exercises required to progressively load the tendon and encourage healing in just once session! You can then self manage with this information. It may just save you from a long spell away from exercise in the future!