Tendonitis, Tendinopathy, Tendon Strain, Overuse Injury……no matter what we call it we all know that a tendon injury can be difficult to treat and rehabilitation may take longer than other structures in the human body.
The tendon is the continuation of the connective tissue around a muscle that connects a muscle to a bone. Some of the more commonly injured tendons in the body include the rotator cuff in the shoulder, the common extensor origin in tennis elbow, the patellar tendon in the front of the knee and the achilles tendon at the back of the ankle.
Jill Cook is a physiotherapist who has done extensive research into tendon injuries and has published many papers on the topic. She recently released a paper on things not to do if you have lower limb tendon pain!
Complete rest is not recommended.
Tendon pain often relates to how much load the tendon is being asked to take but complete rest may reduce the ability of a tendon to take load and cause muscle wasting. Do not ignore the pain but reduce the load of the tendon to those that it can tolerate.
Do not overstretch a painful tendon.
Stretching adds compressive load and may increase the pain experience. Lengthening the musculotendinous junction is best done by massage and heat applied to the muscle belly and leaving the tendon alone. Massaging an already irritated tendon usually only adds to the aggravation and prolongs recovery.
Avoid multiple injections
Injections of substances into painful tendons have not been shown to be effective in good clinical trials and in some cases injections can cause greater rates of reoccurrence.
Exercise is best practice
Exercise based rehab is best for tendon pain. Don’t take short cuts. A tendon needs time to build its strength and capacity and the long term outcome is good if you do the correct rehab. Understand that the loads in a tendon are greatest when it is used as a spring such as jumping sprinting and change of direction. Slow weights and resistance are not high load for a tendon and can really help repair a painful tendon.
what if I rupture it?
Many clients worry about rupture of a painful tendon. Pain is a protective mechanism for a tendon and makes you unload it. Most people who experience tendon rupture have never had pain prior to their rupture.
If you have lower limb tendon pain your physiotherapist is best placed to advise you of an appropriate rehab program and monitor the loading of your tendon in sport.
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