Regular trouble with tendons
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 firstname.lastname@example.org
Happy training. The most fundamental element of tendon rehabilitation is
Shockwave therapy to help with pain.