“WHY PAIN IS STILL PRESENT DESPITE RESTING FOR DAYS OR WEEKS. A BETTER UNDERSTANDING OF TENDON RELATED-INJURIES
Tendons connect muscles to bones and are avascular tissues, meaning they do not receive adequate blood flow by themselves the way muscles do. Approaching tendon and muscle injuries are not the same and need specific attention based on this very important characteristic. Read below for a better understanding on how to address this commonly injured tissue.
A great explanation can be heard by Dr. Keith Baar, who has spent his career understanding the properties of tendon-related injuires and how to reduce them, as well as reduce recovery time. Podcast episodes can be found here and here
Rest?
The old adage of ‘use it or lose it’ applies to tendons. Complete rest will decreases the ability of the tendon to strengthen. It also affects the muscle attached to the tendon and the rest of the limb, leaving the person with less ability to load the tendon. Conversely, you cannot ignore the pain. You should reduce the load to the level that the tendon can tolerate and then slowly increase the tolerance of the tendon to load.
Injection therapies?
Injections of substances such as cortisone into a tendon have not been shown to be effective in good clinical trials. In fact many of them are based on the false premise that tendons heal like other tissues and that there is a capacity to return a pathological tendon to normal. The long term effects of such treatment degrade the overall integrity of the tissue leading to more pain, greater damage and client frustration. Always remember that there is no quick fix! Do not have injection in a tendon unless the tendon has not responded to a good exercise based program.
Ignoring pain?
Pain that is worsening with a specific movement or position is a way the tendon will tell you that the load may be too much. Pain that reduces as you move is a positive response that tissue is reacting to a fresh supply of blood flow. Reduce the aspects of training that are overloading your tendon and consult with a physio therapist if they worsen or negatively impact your performance. See the block below regarding loading parameters for pain and strength.
Stretching?
Aside from the load on your tendon when you play a sport, there are compressive loads on your tendon when it is at its longest length such as stretching. Adding stretching to most tendons only serves to add compressive loads that we know can be detrimental. Stretching can beneficial if the muscle is appropriately targeted. Additionally, if your muscles are tight, use massage to loosen them but avoid causing a stretch to the irritated tendon.
Imaging your tendon?
The pictures of your tendon with ultrasound and MRI can frighten you, and the words such as ‘degeneration’ and ‘tear’ can leave you apprehensive to move at all.
There is good evidence that the pathological tendon can tolerate loads, especially when you gradually increase the loads on them.
Taking short cuts with rehabilitation?
Taking short cuts with rehabilitation will not help. You need to take the time to allow the tendon to build its strength and capacity. Although this can be a substantial period (up to 3 months), the long term outcomes are good if you do the correct rehabilitation. Treatments promised as cures often give short term improvement but the pain reoccurs when the loads are resumed on the tendon.
Diet?
Including collagen supplementation can provide a major boost in tissue recovery as well as a reduction in injury. Consider these options when you plan on increasing your running, rucking or other training. We recommend brands like Thorne.
Summary:
The take home message is that exercise-based rehabilitation is the best treatment for tendon pain. A progressive program that starts with isometrics and slower tempo will give the tissue time to organize and strengthen. Eventually, quicker activities such as running and jumping can be added. It’s also good to track your training so you can identify potential patterns that may have caused a rapid increase in stress. We use the blackbook for its ability to assess day to day changes in not just training, but sleep, mindfulness and stress.
Strategies:
Use our Tendon Loading Packet for more assistance!
Pain Reduction: Research shows that holding a tendon in a static mid-range contraction (isometric) for 40-45 seconds can drastically reduce pain. Rest 2 minutes and repeat for 2-4 total sets and perform as needed throughout the day to reduce pain.
Slow-Speed Strengthening: Aim for sets of 5-6 reps at speeds of 5 seconds to lower the weight and 5 seconds to raise the weight. Good for allowing tissues to adapt to a new strength training program or helping to balance out high impact programs such as running or plyometrics.