Tendons are tough bands of fibrous tissue found throughout the body that attach muscles to bones. Because they do not relax/contract like the muscle (i.e. they do not work hard) they do not need a large supply of blood – hence when a tendon is injured it heals very slowly.
Causes of tendon injury
There are two main types of tendon injury
- An acute injury where a tendon is rapidly overstretched causing immediate pain, swelling and inflammation – an example of this would be a squash player making a sudden lunge to play the ball and overstretching the Achilles tendon. This is known as a tendonitis.
- An overuse (repetitive strain) injury where there is long term deterioration in the collagen tissue which makes up the body of the tendon without any associated inflammation – this is known as a tendinopathy.
Commonly injured tendons include:
- Achilles tendon
- Tennis Elbow – wrist extensors
- Golfers Elbow – wrist flexors
- Patella tendon – (under the knee-cap)
- Rotator cuff tendons (shoulder)
The best treatment for your injury will depend on accurate diagnosis of the problem and analysis of its origin and causes. The differentiation between a tendonitis and a tendinopathy is therefore significant – the inflammation of tendinitis is treated differently than the deterioration of tendinopathy. Inflammation from an acute tendonitis often responds quickly to rest and anti-inflammatory treatment. However, if the injury is due to tendon tissue degeneration (tendinopathy), treatment may be quite lengthy and will be focused on improving the strength of the tendon and rebuilding tissues. For example, an Achilles tendon injury:
During your first visit we will take a detailed history of your problem followed by a comprehensive physical examination including:
- Examination of the tendon and lower leg
- Examination of the back, pelvis, hips & knees to look for malalignment problems both statically & actively
- analysis of sporting technique (if able)
- foot biomechanics – to look for pronation/supination issues
- Training & activity schedule – are you overtraining or too repetitive in your schedule – we can advise and help you with this.
For an Achilles tendinopathy treatment could include the following:
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- P.R.I.C.E regime, (protection, rest, ice, compression, elevation) – protection in the form of a small heel raise for the shoe or a brace to limit the ankle can help relieve pain and allow the injury to settle in the early stages)
- Anti-inflammatory (NSAID’s) drugs – unlike in an acute overstretching injury (tendonitis) the use of NSAID’s is NOT indicated for a tendinopathy as it may reduce the effects of healing agents naturally produced by the body)
- Soft tissue mobilisation of the tendon and calf muscles to stimulate metabolic activity (healing) and gradually increase tensile strength of the tendon
- Physiotherapy at the back & pelvis (where appropriate) to minimise structural imbalances and asymmetry.
- Careful instruction on a very carefully structured strengthening program for the Achilles tendon and calf muscles – this ‘eccentric’ loading program is the key to successful rehabilitation.
- Referral to a specialist Podiatrist (if appropriate) for custom made insoles to correct biomechanical abnormalities of the foot.
- Supervision of a graduated return to activity and loading of the tendon – for runners this may include ‘pool running’ in our 25m pool as a means of running with reduced impact.
This is just one example of how an injury is assessed and treated at The Village Physios – you can be sure that whatever tendon injury you have your treatment will be specifically geared towards getting you back to normal as soon as possible.