Ten­don in­juries re­quire a care­fully man­aged re­ha­bil­i­ta­tion pro­gramme

Great Health Guide - - CONTENTS - Michael der­man­sky

De­spite the sophistication of sports in­jury man­age­ment and sports sci­ence, ten­don injures are still a very tough area to treat. Over the last fif­teen years, the best-known ap­proach for man­ag­ing ten­don in­juries has con­tin­ued to change and thus the best method of treat­ment is yet to be de­fined. How­ever, a large amount of in­for­ma­tion on ten­don in­juries is un­der­stood and at present, cer­tain treat­ment meth­ods are rec­om­mended for these in­juries.

1. Ten­don in­juries oc­cur when there has been a fast change in how much work the ten­don must do.

For ex­am­ple, if an ex­er­cise pro­gram is in­creased too rapidly, such as, start­ing to run faster or more of­ten, or if run­ning up hills is added to the pro­gram, the ten­dons are placed un­der con­sid­er­able stress. The ten­dons start to cause pain as the break­down of the ten­don oc­curs. These ten­don in­juries usu­ally hap­pen, when the load placed upon the ten­don causes dam­age, that is greater than the re­pair and growth oc­cur­ring at rest and af­ter ex­er­cise. When an im­bal­ance oc­curs be­tween dam­age and re­pair, the ten­don breaks down.

2. Ten­dons break down at points where they are nat­u­rally com­pressed by bony struc­tures.

For ex­am­ple, when the hip is flexed over 90 de­grees or sit­ting cross legged, the glu­teus medi­ums ten­don is com­pressed against the bone at the side of the hip. Avoid­ing these po­si­tions is part of the process of man­ag­ing ten­don dam­age and pain.

3. Heal­ing of ten­dons is slow. They do not heal well as they have a very poor blood sup­ply.

Thus, the treat­ment of the in­jured ten­don re­quires a very well­struc­tured pro­gres­sion of ex­er­cises, such that the load placed on a ten­don is very light while the ten­don is heal­ing. This treat­ment must be care­fully mon­i­tored and of­ten be­gins with iso­met­ric ex­er­cises un­til such time as the ten­don is pain free. Only then can regular ex­er­cises be care­fully in­tro­duced.

4. It is very im­por­tant to ad­dress all the bio-me­chan­i­cal fac­tors that add ad­di­tional load onto the ten­don.

For ex­am­ple, the treat­ment in ad­dress­ing an Achilles ten­don in­jury, will also mean im­prov­ing the strength and con­trol of the hips and knees. This will aid in re­duc­ing the load placed onto the ten­don in the long term.


Be­cause of com­plex­ity of re­ha­bil­i­tat­ing a ten­don af­ter in­jury, I would highly rec­om­mend see­ing a phys­io­ther­a­pist or ex­er­cise phys­i­ol­o­gist who is fa­mil­iar with ten­don in­juries for the best chance of re­cov­ery.

Michael Der­man­sky is a Se­nior Phys­io­ther­a­pist and Man­ag­ing Di­rec­tor of MD Health Pi­lates. Michael has over sev­en­teen years’ ex­pe­ri­ence of treat­ing clients from all walks of life, from six-year-old chil­dren up to the age of 92. Michael can be con­tacted through his web­site.

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