Reg­u­lar trou­ble with ten­dons

Multisport Mecca - - Column - Kate Gaz­zard Sports medicine doc­tor, phys­io­ther­a­pist and ath­lete

ONE of the most com­mon (and frus­trat­ing) in­juries I treat in triath­letes is ‘ten­don pain’.

You may hear terms such as ten­donitis or ‘tendinopa­thy’ which is dis­ease of a ten­don or ‘en­the­sopa­thy’ which is a dis­ease where the ten­don meets a bone (eg at the heel in the Achilles ten­don).

The most com­mon ar­eas are:

Ro­ta­tor cuff ten­dons (swim­mer’s shoul­der)

Prox­i­mal ham­string tendinopa­thy un­der the sit bones

Gluteal tendinopa­thy at the side of the hip

Patella tendinopa­thy at the front of the knee

Achilles tendinopa­thy at the back of the heel

Plan­tar fas­ciopa­thy (also in­cor­rectly known as plan­tar fasci­itis) un­der the foot.

What is a ten­don?

The pur­pose of a ten­don is to con­nect mus­cle to bone. While the spe­cific struc­ture of a ten­don may vary from ten­don to ten­don, the com­po­nents are the same – col­la­gen fi­bres, wa­ter and ‘ground sub­stance’.

It is the com­po­nents in the ground sub­stance that give the ten­don its abil­ity to stretch and re­turn to its orig­i­nal shape.

Ten­dons func­tion like ca­bles to trans­mit the pulling force from mus­cles to bones. They also func­tion like springs to store en­ergy such as the elas­tic re­coil of the Achilles ten­don in run­ning.

Con­tin­u­ally push­ing the train­ing en­ve­lope with high repet­i­tive load­ing can lead to dam­age and break­down of the ten­don tis­sues.

Older ath­letes or ath­letes com­ing back from a break are par­tic­u­larly vul­ner­a­ble to this de­gen­er­a­tion. Ini­tially the ten­don and the ma­trix that holds it to­gether may swell and then the ten­don will de­te­ri­o­rate, un­able to with­stand the train­ing load lead­ing to in­jury and pain. With age, the blood sup­ply to the ten­dons de­creases fur­ther im­pair­ing the body’s abil­ity to re­pair and re­cover.

In some cases cal­ci­fi­ca­tion may de­velop in the ten­don, par­tic­u­lar in the shoul­der. In other ar­eas of the body, the de­gen­er­a­tion of the ten­don may lead to a tear.

So, what do I do, Doc?

ap­pro­pri­ate ten­don strength train­ing along with manag­ing over­all train­ing load. An ex­pe­ri­enced sports medicine pro­fes­sional will be able to guide you through an ap­pro­pri­ate strength re­ha­bil­i­ta­tion train­ing pro­gram.

In mild cases of tendinopa­thy, re­duc­ing load, avoid­ing speed­work or hills, cor­rect­ing biome­chan­ics and con­trol­ling pain may al­low the ath­lete to keep train­ing. A swim coach, tread­mill anal­y­sis or bike fit can iden­tify any ab­nor­mal­i­ties in tech­nique.

Brac­ing or strap­ping for el­bows or knees can some­times help and heel pain may be re­lieved by heel raises in Achilles tendinopa­thy or the tem­po­rary or per­ma­nent use of orthotics in plan­tar fas­ciopa­thy.

Ex­tra­cor­po­real shock­wave ther­apy (ESWT) is a fan­tas­tic ad­junct to the treat­ment of ten­don pain.

The shock­waves de­crease the con­duc­tion of pain sig­nals in the ten­don fi­bres, hence re­sult­ing in sig­nif­i­cant pain relief en­abling an ath­lete to un­der­take their strength re­ha­bil­i­ta­tion. Fur­ther­more, the shock­waves stim­u­late re­lease of chem­i­cals that cause in-growth of blood ves­sels im­por­tant for the heal­ing process.

Treat­ment usu­ally in­volves one ses­sion per week for three-six weeks and has an im­me­di­ate re­sult on pain and dis­abil­ity.

Shock­wave of the plan­tar fsa­cia

Cor­ti­sone in­jec­tions are not rec­om­mended in tendinopa­thy. They may pro­vide short term relief but the long term out­come may not be im­proved. It must also be used with cau­tion as corstione weak­ens ten­don tis­sue pre­dis­pos­ing it to rup­ture.

Platelet Rich Plasma (PRP) is the process of har­vest­ing the platelets in the ath­lete’s blood and in­ject­ing them into the area to be treated. Platelets take part in the nat­u­ral process of heal­ing by form­ing a clot to seal off an area of in­jury and also re­lease chem­i­cals that helps of heal­ing.

This pro­ce­dure thus aug­ments the body’s nat­u­ral heal­ing process. Cur­rent re­search shows promis­ing re­sults for tendinopa­thy and en­the­sopa­thy and for ro­ta­tor cuff tears. One-three treat­ments may be needed once a month.

In se­vere cases where the pain is per­sis­tent de­spite the above treat­ment, surgery may be nec­es­sary to re­lieve the painful con­di­tions.

The take home mes­sage from me – the sooner a ten­don is treated, the bet­ter. If an ath­lete keeps push­ing the re­sult may be a nig­gle that turns into a chronic tendi­noathy last­ing 18 months to two years or a to­tal rup­ture.

Lis­ten to your body. Take ad­e­quate rest and re­cov­ery and of course, don’t be afraid of strength train­ing.

If you have any ques­tions or if there is a topic you’d like to hear more about in the next Mul­ti­sport Mecca edi­tion, email drkate@the­p­ro­

Happy train­ing. The most fun­da­men­tal el­e­ment of ten­don re­ha­bil­i­ta­tion is

Shock­wave ther­apy to help with pain.

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