The tendon is the structure that connects your muscle to a bone. As the muscle contracts it generates energy which is then transferred to a joint via the tendon. Like the rest of your body, the tendons are continuously adapting dependent on the forces that are going through them. Like the muscles that they attach to, tendons will become stronger if their workload increases and weaker if their workload is reduced. A problem can occur if this workload changes too quickly so that the tendon does not have enough time to adapt and therefore is not strong enough to cope with the demand.
WHAT THE RESEARCH SAYS
In 2009, some excellent work by Jill Cook and Chris Purdham described the process of tendon adaptation as a continuum. They describe how a normal tendon can move into 4 different states depending on how much load and how long that load is applied. This provides a useful model for staging tendinopathy based on the changes and distribution of disorganisation within the tendon
In 2016, this model was revisited by the authors and updated with the latest research. This is an excellent piece of work but can be a little complicated for non clinical / scientific people. If you want to learn more then follow the below link.
A tendon will become reactive in a number of circumstance:
REPEATED OVER TRAINING
This most commonly occurs when someone increases their training quickly. This might be increasing duration of training, number of repetitions or frequency of training sessions. The type of training can also influence the load going through the tendon eg sudden increase in hill training in someone who has only run on the flat
TRAINING AN OLD INJURY
As shown in the tendon continuum model, it is thought that a reactive tendon will start to fail its healing process and lead to a degenerative tendon if not appropriately treated. A section of degenerative tendon is unable to transmit force through it and therefore puts additional strain on the healthy parts of the tendon around it. The degenerative section itself is not necessarily painful and therefore the tendon with a previous degenerative section ’ may flare up with relatively little load because the healthy part of the tendon has to work a lot harder to compensate for the degenerative part. This may feel like your old injury flaring back up but it is likely to be a new reaction as a result of the old injury.
NORMAL LOAD THROUGH A WEAK OR DISUSED TENDON
When a tendon is not used its structure becomes weaker. This may happen following another injury that limits movement (eg after immobilization during a fracture) or when someone has been quite inactive through illness, age or life style. The tendon may not be able to tolerate what you may consider as ‘normal activity’ without reacting and becoming painful.
TREATMENT
Treatment for a tendon injury depends on where in the continuum that injured tendon is:
REACTIVE STAGE
At this stage it is important to reduce the load on the tendon and deal with any inflammatory chemical that are being produced by the body. This means appropriate medication, reducing the load through the tendon by either rest or modifying your activities and things like icing the area.
TENDON DYSREPAIR & FAILURE
At this stage it is important to strengthen the healthy tendon around the degenerative areas so that the tendon can cope with the activity you are asking it to do. An effective way or achieving this is through progressive loading of the tendon with exercises. It is important to load the tendon correctly so that it does not become too reactive but is stimulated enough to start laying down stringer healthy tendon tissue.
OTHER TREATMENT OPTIONS
There are a number of other treatments that have been used for treating tendons in the past. These include injecting steroids, platelets from your own blood and alcohol. There is also shockwave therapy that is used in some places. These treatments have mixed evidence to support them and are still trying to stimulate the degenerative tendon to heal rather than adapting the healthy tissue around them.
TENDON TEAR
Although tendons are very strong they can occasionally tear. This often involves a trauma and a feeling of something snapping or popping. Sometimes a degenerative tendon can tear with a releatively minor force but this is rare.
If you get a sudden increase in pain after with a feeling of something tearing followe but an inability to move that area properly, then you should seek medicaly attention quickly as an early diagnosis improves the long term outcome.
The experts at the Performance Lab will be able to diagnose your tendon injury and explain which part of the continuum you are in. They will then provide you with a bespoke program to get you back to the things you love doing as soon as possible.