Tendon pain. What can be done?

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Erika Joseph
5 years ago
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1 Tendon pain What can be done?

2 Contents 1. Introduction to tendon s (what are they?). 2. Common Tendon s that become painful. 3. Tendon pain (Why is my tendon painful?). 4. Treatments for Tendon pain (what can be done about my painful tendon?). 5. Scanning tendons (what does my scan mean for me and my tendon?).

3 What are Tendons...? Tendons are soft tissue structures that connect a muscle to a bone. They are thick bands made up of collagen (which provides tendon strength) and Elastin (which provides tendon flexibility). Tendons work to transmit the force generated from the muscle to move the bone. This allows us to move our body as we do on a normal day-day basis. That means that every time you move your arm or leg your tendons are working hard to transmit these forces. Health professionals call this force Load. This is a simplified version of the relationship between a muscle, bone and tendon.

Patellar tendon: The Patellar tendon attaches your knee cap to your shin bone (tibia).

4 Common Tendon s that become painful Achilles tendon: The Achilles tendon attaches your calf muscle to your foot. Its main role is for walking and running. Patellar tendon: The Patellar tendon attaches your knee cap to your shin bone (tibia). Its main role is for jumping and landing. Gluteal tendons: These are a group of tendons that attach your buttock muscles to the outside of your hip. Its main function is to stabilize the hip during weight bearing.

Tibialis posterior tendon: This is a tendon that attaches to the inside of the

tendons: These are a group of tendons that attach to the front of your shoulder.

5 Tibialis posterior tendon: This is a tendon that attaches to the inside of the foot. Its main function is to support the arch of the foot Rotator cuff tendons: These are a group of tendons that attach to the front of your shoulder. Its main function is to stabilize the shoulder whilst moving the arm (like throwing a ball). Forearm extensor tendons: These are a group of tendons that attach to the outside of the elbow. Its main function is for gripping and lifting objects.

6 So you know what they are and where they are but WHY is my tendon painful?

Active population with tendon pain If you are an active person over a long period of time, or trying to become an active person by increasing your exercise,

7 Who Gets Tendon Pain? The answer to this question is straight forward Anyone can get tendon pain! Whether you are a top athlete, weekend warrior or coach potato. Active population with tendon pain If you are an active person over a long period of time, or trying to become an active person by increasing your exercise, then you may be at risk of developing tendon pain. Being active is a GOOD thing! However, exposing your tendon to high loads repetitively over a period of time can lead to changes in the structure of your tendon, which makes it bad at its function, which causes pain. Even top athletes can develop tendon pain.

8 Similarly, if you have been fairly inactive and decide to make a change (it s time to get fit!) and have taken up a new activity (and haven t eased into it gradually), then it is likely that your tendon is not structurally prepared to cope with that activity, It has poor function for that task, leading to the development of pain. Inactive population with tendon pain Lots of people that are inactive develop tendon pain. There are two main reasons for this. Inactivity makes it more likely that your muscle tendon unit will become weak. Inactivity also leaves you at a higher risk of developing conditions such as diabetes and obesity which can also weaken the tendon. Once the tendon is weakened it becomes poor at its function and will become painful.

9 Risk factors for Tendon pain Age: The older you are the more at risk you are of developing tendon pain. Diabetes: Can cause changes to tendon structure and so weaken them. Obesity: Will cause increased load through tendons due to increased weight but will also affect the tendon structure. Steroid injections: If you have had previous steroid injections it is likely that these have weakened your tendon. History of injury: direct injury to a tendon can increase chances of developing tendon pain. Recent increase in activity: If you have suddenly increased your activity/load and your tendon is not used to it. Previously having tendon pain: If you have had it before you are more likely to have it again. Poorly managed training: Training on hard surfaces, over-doing your training, training without enough rest periods, Training without correct footwear etc. Muscle strength: the muscle and tendon work as a unit. If the muscle is weak then it is likely that the tendon is also weak. If you have multiple risk factors then the likelihood of developing Tendon pain is higher.

Treatments for Tendon pain 1. Resting As discussed, the tendon can become painful by going above its load capacity. One way to make the pain better is to ensure you do not go above the load capacity.

10 Treatments for Tendon pain 1. Resting As discussed, the tendon can become painful by going above its load capacity. One way to make the pain better is to ensure you do not go above the load capacity. It is important that you recognise when your symptoms come on. For example you walk for 30 minutes and then your pain starts, this walking for 30 minutes has taken you above the tendons loading capacity. To settle your pain down make sure you do less than 30 minutes walking, make sure you take a rest regularly to allow your tendons to have a break. For some people their load capacity will be so low that any movement is painful, they need to make sure they rest in the short term to allow their tendons to have that recovery and rest. If you can, still continue your activity but at a reduced level as this will prevent the muscle/tendon from becoming weaker.

11 2. Loading Exercises Once you are managing the pain better with periods of rest, it is time to start improving the load capacity of your tendon. As mentioned before the reason the tendon is becoming painful is that it isn t strong enough to do the task that you are asking it to do. You will need to re-train your tendons to do the tasks that you want them to do by gradually loading them. This can range all the way from training them to do high level sport, to training tendons to be able to do your weekly shop. This all depends on you as an individual and what you need to be able to do for your lifestyle. You can begin by exercising to gradually load your tendon and improve its load capacity (please see exercise sheet links attached to this manual). As this gets better you will gradually find that you are able to do more and more without the pain. As you improve you need to gradually increase the volume (how many reps

12 and sets you do) and the load (how much weight you are using) of the exercises to continue improving. Once you can achieve what you need to be able to achieve without pain then the rehabilitation is complete. BUT once your tendon is effective at loading you have to maintain this by exercising twice per week. This will minimise the risk of the Tendon pain coming back. How Do I Know I Am Doing My Exercises Correctly? 1. Exercise and pain We discussed before that resting and staying out of pain is an important part of your rehabilitation. So providing exercises that might be painful seems to be a contradiction. However, to get any changes in the tendon and to improve that load capacity we need to exercise the Tendon. If you have pain during the exercise it is ok AS LONG AS IT IS TOLERABLE. If the pain is bad and you cannot stand it then stop as you are aggravating the tendon. If you have pain 1-2 hours after the exercise this is ok AS LONG AS IT IS TOLERABLE. If you have pain all day, all evening and the next morning THIS IS NOT OK. This means that you have done a bit too much and the exercise has taken you above the loading capacity. Do not panic if this happens, this will not cause

13 damage to your tendons. All you have to do if this occurs is to rest your tendon, wait for the pain to come down and then go back to the exercise. When you go back to the exercise reduce the amount of reps and sets, reduce how hard you push or the weight that you use. This will hopefully find a level of exercise for you that work the tendon but does not flare up your pain. The higher the load you do, as long as it is tolerable, the better it is for the tendon. This is because with higher loads you are more likely to wake up the tendon, which will stimulate it to heal and strengthen. A good way to measure pain with exercise is the traffic light system Green light= 0-4/10 pain (good level) Amber light= 4-7/10 (medium level should probably stop exercising) Red light= 7-10/10 (high level stop straight away)

14 But my scan says my Tendon is torn? We have to be careful with ultra-sound scans. They only show a small part of the tendon, NOT the whole tendon. This is because ultra-sound scans are only a 2D picture of a 3D structure. On a U/S scan they may find an area of damaged tendon and it makes people think that their entire tendon looks like that. This is not the case! There will still be lots of healthy tendon that we can work with and build upon. Unfortunately words like torn are used commonly which can be misleading as using a word like torn can make people fearful of using their arm or leg and makes them feel that they need a surgery to fix the tendon. Ideally surgery should only really be considered is if there is a full complete tear of a tendon as this cannot be loaded with exercises. In summary, please do not fear loading your tendons, even if the scan shows there is an area of damage to a tendon, there is still going to be a lot of healthy tendon to work with. Alternatively if you do not load your tendon it will only get weaker.

15 Achilles tendon exercises 21a652e29e441d_5FC29A3 Return to running advice

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