Are you Dealing with Tendonitis?
4 min read
Understanding your stage of tendon pathology plays a role in determining both your prognosis and the most appropriate course of action to better facilitate a return to performance.
Understand the anatomy
Before we gain some clarity, let’s understand what a tendon is. A tendon is the tissue that connects muscle to bones. The force that a muscle produces is transmitted via tendons to your bones to produce movement. As you can imagine, adequate health of tendons is crucial for pain free, efficient movement. The function of transmitting high forces for movement, coupled with limited blood supply, make tendons a susceptible tissue to injury.
What is tendinopathy?
Tendinopathy is the overarching term used to describe an injury to a tendon causing pain with activity, swelling, and stiffness. The state of your tendon lies on a continuum, ranging from an acute reactive phase to a degenerative phase. Although these phases are not discrete, “in between'' each of these phases is a reparative phase, in which your body will heal itself if you allow for proper rest and appropriate exercise modifications. If you make no changes, your tendon can progress into the degenerative phase, at which point treatment typically requires more than simple activity and load modifications.
A common location of pain in those who are dealing with achilles tendonitis.
What you should be doing in the short term
In any case, your tendon is likely painful and causing a frustrating decrease in output & performance. If this describes you, consider the following plan of care, some of which you can incorporate in today!
Isometric & Eccentric strengthening: maintaining tendon and muscle length during contraction (isometric) has been found to successfully reduce pain with tendinopathy. Lengthening a muscle during contracting (eccentric) has also been found to successfully treat tendinopathy. Both types of muscle contraction are keys to tendinopathy recovery, reference the video and caption below.
Videos on the left are examples of calf/achilles isometrics. We typically plug in 4 sets of 45 seconds into our clients routines. Videos on the right are progressions of isometrics to more of an eccentric calf/achilles bias. We typically plug in 3 sets of 8 reps into our clients routines.
Deload & active recovery: we determine which qualities our clients are lacking (mobility, strength, elasticity, etc.) and temporarily manipulate training volume to afford time to build up the aforementioned quality that is lacking in a scalable fashion. The manipulation of volume allows their tendon to heal from the acute reactive phase while optimizing the lacking quality to safeguards against a subsequent flare up.
Adjust biomechanics: in the case of runners, if running gait optimization is warranted this is something we provide. However, there is most often lower hanging fruit that is pursued first including strength and elastic capacity.
External support: support that reduces tensile & compressive stress such as orthotics, bracing, or taping are to only be used in the early stages, as you should eventually be able to maintain the support they provide on your own through targeted intervention.
Massage: friction to the tendon stimulates circulation to the tendon. Massage to the muscle can also decrease tension the muscle is placing through the tendon, slowing the degenerative process.
Although these are not long term solutions, they will help you manage the pain until you decide to address it once and for all. Longer term solutions would be aimed at improving local joint mechanics, increasing strength, and building the tendons capacity to better meet the demands of your goals!
Conclusion
Although these techniques are only the basics of tendon care, they can still have a profound impact regardless of the phase of tendinopathy you are currently in. Without the proper requisite qualities of mobility, strength, rate of force development, and endurance, your tendon's ability to handle your daily demand decreases rapidly. If you are interested in hearing more about what to do after implementing these initial steps, book a free discovery call!
References
Bass E. (2012). Tendinopathy: why the difference between tendinitis and tendinosis matters. International journal of therapeutic massage & bodywork, 5(1), 14–17. https://doi.org/10.3822/ijtmb.v5i1.153
https://staugustinefootdoctor.com/achilles-tendonitis-st-augustine/
