Many of you will have heard of the terms tendinitis or tendinopathy…some of you will have even had the misfortune of experiencing the disruptions it can cause to your training or worse, to day-to-day activities!
Lets be honest, this condition hangs around like a bad smell! The inconsistency in its presentation can drive you insane…it doesn’t take much to flare it up, but on any given day, it could feel like its miraculously disappeared, giving you false hope that you’ve recovered, only for it to come back with a vengeance.
Tendon Injuries are the most common type of Injury we see here at our Physio clinics in South Yarra, Kew and Hawthorn in Melbourne which are primarily constructed to house high level strength & conditioning athletes, CrossFit athletes, Powerlifters and olympic weightlifters.
First things first… What is a tendon and how do they get injured?
Tendons are tough bands of fibrous connective tissue that usually connect muscles to bones. They are known to withstand tension/load and depending on where they are in the body, can have the function of acting as a spring to help generate force and help with efficiency in movement.
Common places to have a tendon injury are:
Essentially tendon injuries occur when an increase in load or volume exceeds the tendon’s capacity. These can be caused by both intrinsic factors (i.e. poor biomechanics, decreased strength etc.) and extrinsic factors (i.e. changes to training volume, surfaces or environment).
It has also been proposed that the model of tendon injury is a continuum. This is why there isn’t a one-size-fits-all concept to treatment. Identifying where you are on this continuum determines how your tendon injury should be managed.
A typical tendinopathy sufferer may experience stiffness and pain at the start of training, then often “warms up” to less pain….but then some acheyness follows after cooling down….(does this sound like you?! Keep reading….)
Essentially, each time you rest, your tendon capacity lowers/gets weak (there is no stimulus for protein production and no maintenance of the muscle tendon unit)
So when the pain goes away, and you resume training at the load you left off at, the ability of the tendon to cope is now even lower…thus pushing you further down the continuum of tendon change
So what does this all mean? What can I do to break the cycle?
First of all, lets be clear on one thing. Tendons actually like load. The key to whether you “make or break” is about managing the right type and volume of load and allowing time for your tissue to adapt.
4 Ways to Create Invincible Tendons for Improving your Athletic Performance
1. Reduce Pain and Swelling Levels
The Physios here at Evolutio who work primarily with CrossFit, Powerlifters and Olympic Lifters are great at helping with this, be it with our hands on work and/or advice on how to modify your current levels of activity (which doesn’t mean stop everything!)
This is not just to make you feel more comfortable, but it is to allow you to start/continue with a specific rehab program to increase your tendon capacity. Sometimes the use of anti-inflammatories such as ibuprofen (the best non steroidal anti inflammatory that is most effective on tendon pain) is necessary. **
2. Get Strong!
Yes! Load up! …. But in small increments over time and with the right type of exercises.
Eccentric only programs were all the rage at one point in tendon management, but just like a popped collars and crocs, we don’t think it’s all that cool anymore. Think about it this way, if we are trying to increase the capacity of a tendon to be able to cope with the loads that it is subjected to in physical activity that involve functional movements and multi-jointed exercises, why would we only work it in one way? This does not replicate real life, therefore will lack some carryover! Concentric and Eccentric is therefore a no brainer!
Maintenance of general strength of the rest of the kinetic chain is also super important! For instance, don’t let your quads and glutes get weak just because it’s attached to the Achilles that’s sore!
3. Vary your Loads
This concept is not new in the fitness industry when it comes to building strength and getting results. So why not apply it to our rehab. If we know that a tendon injury is due to overuse from repetitive loading then why would we prescribe something that is also high in load and volume (the ol’ 3 x 15 !!!) Instead we take these into consideration-
o Tendons have a delayed response to load (at least 24-48hours), hence the morning after pain
o We need to manage any load inducing pain within a rehab program in order to allow continuation of the program
o Every individual has a different baseline
o Rehab does not just stop when pain goes away
A good rehab program for tendons should include high load, medium load and low load days and continually change to push the tendon’s capacity up. A program that is too low in load is just as detrimental as one that is too high in load! Tricky!
4. Advanced Work
Once there is base strength and a reduction in pain, we need to bring in speed and power. Acceleration/deceleration, tempo with lifting, sports specific drills etc
SO….What are the take home messages?!
· Load is what can “make or break” a tendon- get it right!
· A rehab program which gets you to do the same things every single day is not likely to get you the results you want when it comes to tendon rehab
· Complete rest may not necessarily be the best approach
· Good things take time, so does tissue adaptation. Be patient!
· An individualised program like the ones that the Evolutio Physiotherapists can create, are crucial in Rehabilitation. We are the only ones creating Strengthening Programs using the Conjugate system in Australia