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