Tricky Tendon Injuries

Tricky Tendon Injuries

By Michael Tamaddoni: Senior Physiotherapist at Your Health Domain

Injuries to tendons in our body are quite common, and the Physiotherapists at Your Health Domain are seeing a large number of clients present with tendon pain, most commonly in the Achilles, shoulder and elbow.  The tendon is the tissue that links our muscle to the bone, allowing movement at our various joints throughout the body.  As the muscle contracts it pulls the stiffer tendon and with it the bone that it is attached to. 

Tendons are made of dense collagen fibres which are not as elastic and stretchy like muscle tissue.  The stiffness of the tendon makes it a great structure for transferring load or force from the muscle to the bone.  However tendons are susceptible to injury especially when they are over-loaded or too quickly loaded when they are too weak.

An injury to a tendon can occur in a number of ways:

  • An overload of force on a tendon: doing heavy squats at the gym can affect the patella tendon in the knee.
  • The tendon is compromised by a mechanical force like compression: poor posture at your desk can compress the tendons of your shoulder.
  • A quick stretching/pulling: your dog pulls hard on the lead and irritates the tendons of the shoulder, or you re-join your local basketball team and try to slam-dunk!
  • Repetitive high or low load:  hours of typing at the desk can lead to pain at the tendons of the elbow, or running can affect the Achilles.

When this happens the tendon is damaged and typically we feel pain.  This type of injury could occur while running, working, playing sport, or even walking.   A typical presentation is a seasonal runner who begins training for an event like the City 2 Surf.  During their training or during the event they end up having some pain around a joint like the knee or Achilles. The runner will either continue running through the pain, or stop running and exercise altogether and resume their running when it is pain free to do so.  The latter sounds like a good idea.  However, recent research and imaging of tendons tell us this is not a great approach in dealing with tendon-related pain. 

When a tendon is injured only a portion of the tendon is injured.  That part becomes known as the degenerative part of the tendon or the “unhealthy” part of the tendon.   That part will always be degenerative.  However there are still healthy parts to the tendon, and these are the parts the Physiotherapists of Your Health Domain are concerned about and can make changes to.  The way we increase the overall strength or load that the tendon can take on is through strengthening the healthy bits of the tendon.  With a structured progressive tendon specific strength program devised by your Physiotherapist, you can enhance the ability of the healthy part of the tendon to be able to take on more load or force as the tendon adapts to the demands of force put on it.  This is important when trying to help patients return to activity or sport. 

   Caption: Healthy tendon = Green, Acute Injured Tendon = Blue, Degenerative/Damaged Tendon = Red

The common misperception of giving the tendon rest until pain is gone and then resuming activity level at the previous level is actually detrimental to tendon health.  This is because the healthy portion of the tendon after an injury becomes weaker when you stop loading it.  Then, when the person resumes the activity at the previous level they have fewer bits of healthy tendon and the healthy portion is weaker.  Again, this is a recipe for disaster for that specific tendon.  The tendon will typically get overloaded again and the person will have similar symptoms.  This is where the issue goes from a one-off acute injury, to a chronic issue with multiple occurrences therefore causing more damage to more parts of the tendon as seen in the photo above.  It is also why it is important to seek the proper treatment from your Physiotherapist for an injury to a tendon and have them guide you through a rehab protocol to first eliminate pain/symptoms without letting the healthy portion of the tendon become weaker. 

At Your Health Domain we know about tendon pain and how to deal with a rehab progression for both chronic and acute tendon injuries.  We will get your tendon back on track, no matter how severe your issue may be.     

To make an appointment to see a Physiotherapist at Your Health Domain at our Pitt Street or King Street clinics, call 9251 5111 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

 

References:

Cook JL & Purdam CR. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43; 409-416

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Pitt St. City Practice

Address:
Level 7 60 Pitt Street Sydney 2000
Hours of Operation:
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Telephone:
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