Tendon Injuries
Structure and Function of Tendons
Tendons are important structures which attach muscles to bones. Forces generated in the muscle, are transmitted through the tendon, to the bone, causing movement at a joint.
Collagen, an inelastic protein substance, is the primary building block of tendons. Collagen molecules group together into ever increasing size of fibers, which in turn group together to form the actual tendon. In a resting state, the tendon assumes a crimped or wavelike appearance. This crimp is straightened when a load is applied to the tendon. If the load is not too great, the tendon will return to it’s original resting length when the load is taken away. Although very rare, a tendon will rupture if too great a force is applied to the tendon. The amount of force that a tendon can withstand is dependent on how thick and on how long it is. The thicker and longer the tendon is, the more force it is able to withstand before being damaged.
Tendon Injuries
Tendons will weaken and become more susceptible to injury when they are not used. Conversely, as increased activity places greater stresses on these tissues, they adapt by increasing in size and strength. If the loading of the tendon is repetitive and causes the tendon to fatigue with no time for recovery, injury rather than growth and strengthening will occur.
Overuse injuries are the result of excessive loading of a tendon which has weakened by inactivity, or by repetitively loading a normal tendon with large loads.
Tendinosis vs. Tendinitis
Tendinitis is the term used to describe inflammation of a tendon. For a short while after an acute injury, inflammation will be present. Often, however, tendon injuries are treated as if inflammation is the cause of the long lasting pain and dysfunction. Recent research has shown that, in most cases, chronic, overuse tendon conditions do not involve inflammation. Rather, the problem seems to be a result of collagen breakdown, a condition known as Tendinosis.
Tendinosis Diagnosis: Clinical Significance and Resultant Treatment
The correct diagnosis of tendon dysfunction is very important since it determines how treatment should be administered.
If a tendinosis is treated early, it will take 6-10 weeks for full recovery. Many people, however, are unaware of the seriousness of beginning aches and pains, whether they be from work or sport. Often, if their pain disappears after a short warm-up, they will continue to work/play without seeking out proper medical advice/treatment. The result is chronic overuse tendinosis which can take 3-6 months for full recovery. An understanding of this is important for the treating practioner(s), insurance providers, coaches and or employers.
Since it is mechanical overload which causes the tendon to breakdown, it is imperative that the cause of the overload be identified. Often times training errors are to blame. Footwear, incorrect use of equipment (eg. tennis racquet), incorrect body mechanics and/or muscle imbalances (tight/short/weak muscles) have also been found to be at fault.
- Braces which help to unload a joint and the surrounding tendons may help in the healing process although controlled trials have not been done to prove their efficacy.
- Anti-inflammatory medications and modalities have little benefit in treating a tendinosis since there is no inflammation. Laser, ultra-sound and electrical modalities used by physiotherapists have been shown to stimulate collagen production and are therefore useful in promoting healing.
- Strengthening the muscle/tendon complex is key to proper rehabilitation and full return to pre-injury function. Specific strengthening exercises stimulate the production of collagen in tendons as well as improve collagen alignment and cross-linking.
- Stretching. A lack of flexibility in the muscles/tendons is commonly seen in areas marked by chronic tendon pain and dysfunction. For this reason a specific and comprehensive stretching program is recommended.
- Nutritional supplements may play an important role in healing as well. It is known that vitamin A, vitamin C and copper are important substances in the production and cross-linking of collagen. A lack of dietary protein, a lack of iron and a lack of calcium may also account for poor/slow collagen production and tendon repair.
- We strive to determine the cause of the tendon problem so that it does not return in the future
- We provide guidance in the type, speed and progression of exercises needed for proper tendon healing
- We provide guidance on the stretches necessary for the healing process to be successful
- We use special equipment to promote collagen production which is essential for tendon repair
- Khan KM, Cook JL, Taunton JE, Bonar F: Overuse Tendinosis, Not Tendinitis: Part 1: A New Paradigm for a Difficult Clinical Problem. The Physician and Sportsmedicine 2000; 28(5):1-9
- Magee DJ, Quillen WS, Zachazewski JE: Athletic injuries and Rehabilitation. Philadelphia, WB Saunders, 1996, pp 27-50
Why Pro Motion Physiotherapy?
Treatment at Pro Motion Physiotherapy is beneficial for the recovery from tendon injuries for the following reasons: