PHYSIO COR­NER

Don’t let ten­dons be your Achilles’ heel, says Six Physio’s Luke Kell­away

Triathlon Plus - - Contents -

Sort on­go­ing ten­don in­juries.

The triathlon world is no stranger to ten­don pain. If you were to ask around your club, I’m sure you’ll hear dif­fer­ing ad­vice on how to rem­edy ten­don pain. The truth is, our un­der­stand­ing of ten­don pathol­ogy and re­ha­bil­i­ta­tion is still evolv­ing. How­ever, the most con­sis­tent theme among ten­don gu­rus, is load man­age­ment.

A ten­don is the non-con­trac­tile tis­sue that con­nects mus­cle to bone. They are formed from tightly packed col­la­gen fi­bres that store and trans­mit en­ergy to its skele­tal at­tach­ment. Ten­dons have the abil­ity to stretch (think of an elas­tic band) and store ki­netic en­ergy. When the ten­don re­coils, the en­ergy can be re­leased and max­imise the force that the mus­culo-tendi­nous unit cre­ates.

Ten­dons need to be main­tained with sen­si­ble lev­els of load­ing. A tendinopa­thy oc­curs when a ten­don is loaded too much or not enough. Pro­longed ex­po­sure to one of these ex­tremes will lead to a break down of the col­la­gen fi­bres and pain. This typ­i­cally hap­pens in a heavy train­ing block, lead­ing up to triathlon sea­son. The way to pro­tect your­self from tendinopa­thy lies in pre­ha­bil­i­ta­tion and plan­ning your train­ing blocks.

We know ten­don tis­sue can be bro­ken down with load­ing. How­ever, af­ter the ini­tial catabolic re­sponse to load­ing, a ten­don goes through an an­abolic re­sponse and the tis­sue is re­paired. This process takes around 36-48 hours. There­fore, heavy load­ing should not be per­formed on con­sec­u­tive days. For ex­am­ple, do not per­form your sprint ses­sions on con­sec­u­tive days or heavy heel raises one day fol­lowed by sprints the next. Do not start your sea­son with three long runs over three days if you haven’t run for two months.

The most com­mon tendinopathies ap­pear in the Achilles and patella ten­don. In the Achilles you can ei­ther have in­ser­tional (where the ten­don meets the heel) or mid-por­tion tendinopa­thy (in the mid­dle of the ten­don). In­ser­tional tendinopathies are char­ac­terised by a tender swelling of the heel bone. Mid-por­tion tendinopathies ap­pear as a painful lump within the ten­don. Patella tendinopathies rarely have pal­pa­ble char­ac­ter­is­tics but the pain is felt be­tween the kneecap and shin bone. Most tendinopathies fol­low a grad­ual on­set his­tory and present with ini­tial morn­ing pain. Of­ten the pain as­so­ci­ated with tendinopa­thy can im­prove through­out a run, but I’d strongly ad­vise against run­ning through ten­don pain.

If you are suf­fer­ing with a tendinopa­thy, the best thing is to see a phys­io­ther­a­pist as they will pre­scribe the right type of load­ing ex­er­cises for you. Ex­er­cises for the Achilles ten­don nor­mally in­volve vari­a­tions of the heel raise. Patella tendinopa­thy ex­er­cise pro­grams make use of squat vari­a­tions.

Treat­ment of a tendinopa­thy takes be­tween 6-12 weeks. In this time your phys­io­ther­a­pist should also be able to ad­dress any con­tribut­ing fac­tors, in­clud­ing poor hip and knee sta­bil­ity, footwear, run­ning style and ca­dence.

Try my top five ex­er­cises for pre­vent­ing Achilles and patella tendinopa­thy.

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