What are tendons?
Tendons are the soft tissues that joins our muscles to our bones and allow the forces generated by a muscle to be transferred to the bone. There are various reasons our tendons can become irritated and these can vary depending on where the tendon is situated in the body. When our tendons are compressed or overloaded, they can undergo structural change which makes them swollen and weaker to pulling forces. The tendon is then more vulnerable and can become a source of pain and disrupt function.
What causes tendon injury?
There are 2 key things that tendons don’t cope well with:
Sudden changes in load.
The load on a tendons is the amount of tension generated by our muscles and their attachments to bone. The frequency, intensity or length of time we are participating in a sport or exercise affects the load on a tendon.
Tendons do not cope well with complete rest either. They become ‘mushy’ and then take time to build up their capacity to take load again. For example: if someone is unwell or very sedentary for a long period and then suddenly start walking long distances, the tendons on the outside of your hip can become reactive and painful. As physiotherapists we saw examples of this during the COVID-19 pandemic.
As a population we were unable to participate in our normal sporting and recreational activities such as netball and football, which reduced the overall load on our tendons. When the COVID-19 restrictions eased, we went straight back to training and playing like we had been participating prior to the lockdowns without any build up. Also, when the gyms were closed and we were spending more time at home, people took up new activities to keep themselves fit including exercise classes via zoom, walking and running more than they usually would. Rapid increases in load like this do not give the tendon enough time to adapt to the stress we are putting it under. This causes a cascade of events within the tendon causing the fibres to become disorganised.
When the tendon becomes painful after an acute increase in load it is called a reactive tendinopathy. If the pain has been ongoing for greater than 12 weeks this phase is called a degenerative tendinopathy.
Compression
Compression of tendons can also contribute to the triggering of tendinopathy. Compression can be a shoe with a hard heel counter pressing into the back of your achilles or it can be the gluteal tendons being squished onto the outside of your hip bone by lying on your side or by crossing your legs in sitting. Another example is sitting on a hard surface and pressing the upper part of your hamstring into your ischial tuberosity (bony part of buttocks we sit on) Tendons can also be compressed and irritated by a direct blow to the tendon such as falling onto a hard surface and hitting the front of your knee just below your knee cap.
Change in hormone levels can also affect our tendon health. Post-menopausal women and men on hormone treatment to reduce testosterone levels are more prone to aggravating their tendons.
Which tendons are prone to tendinopathy?
Any tendon can develop a tendinopathy, but the common ones include gluteal tendinopathy, patella tendinopathy, tennis elbow, golfer’s elbow, rotator cuff tendinopathy and achilles tendinopathy.
How is tendinopathy treated?
To keep our tendons healthy, we need to
- avoid sudden changes in load and gradually return to sport or exercise
- keep our muscles and tendons strong with appropriate exercises
- avoid compression of the tendons across the bones next to them.
If you have tendon related symptoms it is important to be guided in
- how to increase your loading gradually without flaring up your tendinopathy
- which exercises or stretches you should avoid
- how to progressively strengthen your muscles and tendons, and return to the activities you enjoy.
Tendon health and rehabilitation is a an area of special interest to the physiotherapists at Eastern Sports and Spinal Care who are very experienced and passionate about helping you recover well.
If you are experiencing any pain that you feel may be tendon related phone 83310606 today and book an appointment to get the help and guidance you need to return to the activities, you love.
Tips for management of Lateral Hip Tendinopathy (PDF)