Why do tendons become painful?
Tendons get irritated when they are overloaded either:
Gradually – when activity demands become higher than the capacity of the tendon
Acute – a one off overload situation such as the day after busting out some extravagant dance moves in poor footwear at a friend’s wedding.
What actually is a tendon?
It is the structure that connects a muscle to a bone and works as a spring to store and release energy.
When should I seek help for my tendon problem?
It is important to identify the causes and address these as soon as possible. These natural springs in our body work best when they are stiff. The longer we carry these grumbling tendons along the more ‘loose’ they become not allowing them to store and release energy.
Do I rest it to get it better?
No, rest does reduce tendon loads but also reduces tendon capacity. Therefore making it easier to aggravate when returning to activity.
The best plan is to find out and do the right amount of activity. This normally involves doing more of the activities that help and reducing or substitute things that aggravate it.
What needs changing?
This directly relates with what caused the overload which is very individual in nature. However the most common things we address for grumpy tendons are:
- Load modification– find the optimum amount that allows our tendons to improve without ‘going backwards’ from long periods of rest
- Build strength in key areas that reduce pressure on that tendon
We also need to consider:
- Biomechanics
- Other relevant areas deficits in strength, power or endurance
- Training surfaces
- Footwear
- General health issues
Anything I shouldn’t do?
We need to be careful with aggressive passive stretching that can actually add compressive load to the tendon and aggravate it even if it feels tight. Another option to use is massage or foam rollers to release the associated muscle tension.
Do any of the other treatments I’ve heard about work?
Shockwave treatment to the tendon may facilitate in reducing tendon pain if this is a big barrier to exercise and rehabilitation. It can be a helpful adjunct to exercise when used on the appropriate tendon.
Any other tips?
Be patient. A well-structured exercise program is the best management plan for tendons so give it and your body the best chance to heal itself.
What the evidence tells us..
Isometric & slow isotonic exercises are effective for pain relief
Rio, E., Van Ark, M., Docking, S., Moseley, G. L., Kidgell, D., Gaida, J. E., … & Cook, J. (2017). Isometric contractions are more analgesic than isotonic contractions for patellar tendon pain: an in-season randomized clinical trial. Clinical Journal of Sport Medicine, 27(3), 253-259.
Plyometric exercise increasing tendon stiffness (ability to store and release energy quickly)
Kubo, K., Ishigaki, T., & Ikebukuro, T. (2017). Effects of plyometric and isometric training on muscle and tendon stiffness in vivo. Physiological reports, 5(15), e13374.
Strength deficits exist with chronic tendinopathy
Tabuena, A., McCreesh, K., O’Keeffe, M., Hurley, J., Comyns, T., Purtill, H., … & O’Sullivan, K. (2019). Altered Strength Profile in Achilles Tendinopathy: A Systematic Review and Meta-Analysis. Journal of Athletic Training (Allen Press), 54(8).
Load monitoring to go from the floor to the ceiling
Gabbett, T. J. (2019). How much? How fast? How soon? Three simple concepts for progressing training loads to minimize injury risk and enhance performance. Journal of Orthopaedic & Sports Physical Therapy, (0), 1-9.
Shockwave can have immediate pain reduction in tendon injuries
Reilly, J. M., Bluman, E., & Tenforde, A. S. (2018). Effect of shockwave treatment for management of upper and lower extremity musculoskeletal conditions: a narrative review. PM&R, 10(12), 1385-1403.
Steve McAdam
Physiotherapist
BPhysio, MPhysio(SportsPhysio)
