by Janet Leung, RPT
Tendons are fibrous bands which attach muscles to bones, e.g. the Achilles tendon connects the calf muscle to the heel bone. Tendons have some ability to stretch because they are made in part of collagen. They serve a main function of resisting tension (tensile forces). Tendons may be injured as a result of overuse and repetitive stress. Symptoms of injury often develop gradually over time.
Tendinitis refers to inflammatory changes that occur in a tendon immediately after injury. In the very early days following injury, you may see or feel signs of inflammation such as swelling, warmth, redness, pain and tenderness. Patients may be prescribed anti-inflammatory medication for treatment of tendinitis but after a lengthy course some patients still suffer from pain. Symptoms often progress from the initial sharp, stabbing pain into dull aches in the morning, with activity and even at rest. What is happening? Why hasn’t the tendinitis resolved yet?
The answer lies in the fact that in most cases of chronic tendon injury, the pain is not due to the presence of inflammation. The term tendinitis is misleading because treating the inflammation does not treat the root cause of the pain. Tendinopathy refers to degenerative changes that occur in a tendon and is the more appropriate term to describe the condition. Overuse tendon pain is related to microtrauma whereby the structure of the tendon is damaged and broken down. Scar tissue is laid down but not in a neat, organized fashion as it was before. The injured tendon loses some of its elasticity and is less able to resist stress and tension unless it is given the chance to heal properly.
The best way to treat a tendinopathy and stimulate healing is to repeatedly load the tendon below the threshold of pain. This means that neither complete rest nor overaggressive exercises will help. An eccentric exercise program is the recommended way to strengthen an injured tendon.
Your Cross Roads Physiotherapist will advise you on how to take relative rest from activities which aggravate your symptoms. The therapist will also assess the factors which may contribute to tendon overuse including your body mechanics at work or during sports, and the influence of equipment such as footwear or the size of your tennis racquet. You will be taught an eccentric exercise program to load the tendon in a safe and graduated manner. Eccentric exercise generates a higher force and trains the muscle to contract in a lengthened position. It stimulates healing and affects the remodeling of collagen in the tendon.
It is important for patients to have realistic expectations about the recovery time for tendinopathies. The healing and remodeling of a damaged tendon into a strong and functional one is a process which may take many months rather than weeks.
Khan KM et al. BMJ Mar 2002; 324: 626-7.
Brukner P, Khan K (2004). Clinical Sports Medicine (Revised 2nd ed.). North Ryde: McGraw-Hill. p. 24-6.