Tendons are tough as nails. But water the nail enough and it’ll eventually corrode enough to be broken off one by one without the use of any tools. When a tendon stretches too much over time, micro tears develop, leading to pain and inflammation. If left untreated, scar tissue forms back around the area of injury along with an increased supply of nerves and blood vessels. This leaves the tendon painful, weak and at risk of re-injury. This is usually followed by another injury and so on until the chronic inflammation blossoms into a systemic one.
Here are the list of the most common tendon injuries:
- Rotator cuff
- Medial and lateral elbow epicondyles (tennis and golfer’s elbow)
- Patellar tendon (right underneath the kneecap)
- Achilles tendon (above the back of the heel)
In my own practice I’ve seen many in areas like the foot, hamstrings and glutes. Without a thorough assessment it’s hard to give anything specific so here are the best principles I’ve found in recovering from any tendinopathies.
Weeks 1 – 2: Decrease tissue load, control pain and swelling
Use anti-inflammatories and ice to control the pain or swelling if (and only if) it’s unbearable because otherwise the healing process will be hindered. At the same time, start the use of gentle isometrics (muscle contractions without movement) at the area of injury. For example if injured with tennis elbow, hold wrist extensions for 10 seconds for 3-6 sets. Do this multiple times during the day for an effective and safe analgesia. It’ll also help the tendon fibers to heal in the right direction and strength.
Decrease the load of whatever activity led to the injury by at least 50% and if still causes pain then halve it again. Finally, apply some kinesiotape or sports tape to assist with unavoidable activities and provide some compression for improved blood flow. RockTape sells individual rolls of kinesiotape with instructions on how to use them. You can order them online or find them in a local pharmacy.
Weeks 3 – 4: Restore range of motion
If the pain and swelling have settled done by now, start by implementing some concentric exercises. Concentric simply means squeezing the muscles involved to perform movements against gravity. For the rotator cuff it might look like shoulder rotations. Perform them frequently with a total volume of 30 – 50 repetitions a day, resting as needed. It can help to do them with compression such as using a RockFloss band. Continue to use taping for activities if required.
If the pain and swelling haven’t subsided or have returned with a vengeance (!) this means the cause of your injury hasn’t been taken care off. For example achilles tendinopathy can be caused by restrictions in the hamstrings. Get an assessment by a physiotherapist. Doctors won’t be able to do much for you at this stage except numb the pain. You need a movement assessment and a discussion of your lifestyle.
Weeks 5 – 6: Improve capacity
At this point in time, scar tissue should be forming and the area of injury stabilizing. This means less pain with movement. But it also means the greatest chance of re-injury because this is where people think they’re back to where they started and decide to try out for the Olympics. The absence of pain doesn’t signify health. Scar tissue is NOT normal tissue and can cause issues for the rest of your body later on (there’s plenty of research elsewhere on this). For scar tissue to be re-absorbed and tissue to be remodeled that can take anywhere from 6+ weeks to 2 years depending on the area of injury. For tendons, it can take up to 6 months due to its poor blood supply.
Without knowing the specific cause of the injury such as restrictions elsewhere, the best thing you can do is to improve the capacity of your tendon to handle the load. And there’s nothing like improving capacity with eccentric training. This is where the greatest strain is placed first on muscle then tendon in order to lower a load in a controlled manner with the assistance of gravity. For an achilles tendon, it can look like eccentric calf raises. Because of such high stress on the nervous system a lower dosage is required. For eccentric hold of 5-6 seconds you want about 4-5 sets giving you 20-26s of total hold time.
How do you know when to stop? When you can successfully perform basic movements and your sport without injury or pain. At the very least you should have full range of motion at the injured joint and be fairly symmetrical with the opposite limb in range, coordination and strength. There should be no tenderness or swelling at all. Once you’ve checked those boxes off, you’ve officially been rehab-ed. Start the activities you love again but remember to do so gradually and with care. One note of warning however is that if you’ve been fairly sedentary, if have a high amount of restrictions in other areas of your body, or if you struggle with basic movement skills then there’s a significant risk of injury even without pain. Go see a good trainer who can screen you and implement the RIGHT exercise program for you. I recommend the functional movement screen by Gray Cook.
I hope this article has helped you as I’ve tried to be as simple as possible. If you have further questions please don’t hesitate to leave a comment or email. I’m also available for consults at Physio INQ Nepean. Otherwise please share this article or like my page on Facebook to get more simple health content for the everyday guy (or gal).