Pushing through a little niggling pain, hoping it will just get better on its own? Tendon pain is inflammation in the area that connects muscle and bone. Unfortunately, tendon pain can be resistant to treatment and often recurs.
How Does It Start?
Pain in a tendon is a result of a rupture. Now depending on whether you are experiencing a sudden onset of pain, or have been nursing discomfort for some time, these injuries can be classified as either REACTIVE or DEGENERATIVE.
Now one heavy squat session in the gym will not rupture your tendon however prolonged training does result in the formation of a degenerative tendon if your loading is not addressed.
Acute tendon pain or injury = reactive tendon. It is REACTING to the stimulus you have applied either GOOD or BAD.
Tendons are designed to withstand heavy loading and force, so if you apply too much load during a heavy squat session at the gym, your tendon may REACT and become irritable, however, it is extremely unlikely to rupture. On the other hand, if your reactive tendon progresses to become degenerative, you can rupture degenerative tendons and 66% of people have no pain or symptoms.
Continuum of pathology = pain means the tendon has become reactive in response to overload which is different for everyone.
Even a high-level sprinter can change their shoes or the surface they run on and get a reaction in the tendon
For example, often you find older people may head overseas for a holiday and do much more walking than they are used to, carrying multiple suitcases and bags and come back with an injury as it’s not what the tendon is accustomed to dealing with.
As soon as you change the load down on a tendon it changes its capacity. This change in mechanical stiffness can occur in 2-3 weeks.
So what does all that mean?
Well, if you were to have 6 weeks off your regular training for examples, your muscles and tendons and kinetic chain have already become de-conditioned so if you go back to pre-break level training loads you are in fact placing the excess load.
So it is REST and DECONDITIONING that causes overload
Most common types of tendon injury
– Achilles and
– Patella tendon
Exercise Protocol for Tendon Injury
– heavy slow resistance training should be the building block of tendon rehab
– For patella tendon = isometric leg extension holds @ 70% maximum intensity
– For Achilles = training a good joint range so the tendon doesn’t take loads on landing will help prevent injury
– At the beginning of rehab start with standing isometrics then moved to seated during heavy slow resistance phase
– Banded joint ankle mobilization.
– Load progressively with plyometrics
– Split training up into phases = Plyometrics, heavy slow day, endurance day
– Frequency, intensity, and volume all affect the tendon. Change one of these factors and see how it responds or improves.
- Rio E, Kidgell D, Moseley GL, et al Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review Br J Sports Med 2016;50:209-215.
- Rio E, Kidgell D, Purdam C, et al Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy Br J Sports Med 2015;49:1277-1283.