Tuesday, 10 May 2022

Tendons, Tendonitis, Tendonosis?

Tendons attach muscles to bones, so they transmit the forces that generate our movement and also absorb the impact forces of movement.

Tendon injuries make up a lot of my treatments, the most common being either an acute strain (recent) like an Achilles tendon (calf) or a chronic (long-term) rotator cuff (shoulder) pain.

Tendonitis is the inflammation of a tendon. Microtears in the tendon, often resulting from overuse or overloading cause inflammation. This can occur from sporting injuries but can also apply from everyday life overuse i.e. tennis elbow - perhaps from too much DIY, particularly the screwing movement or hammering or shoulder issues from painting and rolling.

If tendonitis fails to heal then it becomes chronic and becomes a Tendonosis, which is the degeneration of the tendon’s collagen, which is a tendon’s main fibrous protein material, and this can occur from overusing the already injured tendon. This can be a vicious cycle and can cause weakness, tearing, pain and prevent you from fully healing and regaining previous strength.

The point where the tendon merges into the tendon is called the musculo-tendinous junction and it allows the force generated by muscle contractions to be exerted on the joints and the skeleton. It is an area which can be prone to injury as it is the primary site of force transmission.

How to avoid tendon injury?

1 - Tendons love consistency - the load they had yesterday is the load they would love today, so when we are increasing the intensity, frequency and volume of exercise we need to make small changes. Intensity is the most important factor to consider to reduce a painful tendon. This is important to consider with your training plans.

This is one of the reasons why the advice for running is do not increase your total volume/intensity etc. by more than 10% per week.

2 - Stiffness - is a positive for tendons, it helps to transmit forces rapidly and without the use of too much energy. If a tendon is too flexible though it is sluggish and doesn’t transmit forces well.

3 - Balance between stiffness and elasticity - there has to be a balance as a tendon that is too stiff will be more susceptible to strain and will compromise the movement and placement of a joint.

Keeping our tendons healthy to minimise tendon injury risk:

1 - Tendon elasticity - can be improved by mobilising the tissue. In a stiff or inflammed tendon there are areas of tight tissues and stretching does not help these areas, as this just tends to “stretch” the areas above and beyond the area of tight tissue. So mobilising the tendon’s tissues is key and it helps to align any scar tissue too. You can try to do this yourself or call on a Soft Tissue Therapist (do call ME to discuss how I can help!). With the Achilles for example the best way to mobilise the tissue is try to push through the tissue creating a “s” shape using your fingers from both hands (look at this picture)

2 - Tendon stiffness - as I mentioned above stiffness is a positive for a tendon and this means doing strength based exercise to increase collagen production and (which as mentioned before is the main structural protein and fibrous tissue of a tendon). This increases its stiffness and ability to cope with load.

Note - strength training doesn’t have to involve the gym and weights, using the body’s own weight with exercises such as single leg squats, lunges, rocking on heels to toes for balance, planks etc.

Tendons do not adapt and heal quickly and hence when incorporating targeted strength exercises into a training plan or recovery plan then this takes time….it can be 12 weeks to 9/12 months to build strength and capacity.

3 - Vitamin C, Hylauronic acid and water - to aid healing and rehab there have been recent studies that have linked the important role of Vitamin C and Hylauronic acid (1) with the production of collagen cells to help strength and Hylauronic acid to reduce inflammation. So maintain healthy diet and/or seeking advice about supplements. Keep well hydrated too as tendons are mostly water.

My aim as a Soft Tissue Therapist is to always treat your specific niggles/pain and to advise on how to manage your injury and rehab self-care exercises. 

If you would like any advice on any specific recent or chronic injuries or pain then do get in contact. I offer 15 mins free Consultations, either by Zoom or face to face.

Nicky Holbrook

Reference (1). https://chronicinjuryandhealth.com/vitamin-c-tendonitis/