Spring has finally arrived, and Alaskans are enthusiastic about recreating in the sunshine. With a change of season, there is usually a change of activities. One of the sure-fire ways of getting injured is doing too much too fast.
Currently, I am transitioning out of cross-country skiing into running and cycling. Although I have a good base of conditioning, I will risk injury by doing too much of a new activity too quickly and not allowing my body to accommodate to the change of load and stress on my tissues. With that being said the tendon is a structure that can become injured due to excessive loading, insufficient recovery and unpreparedness. The result can be a tendinopathy (injured tendon), which can occur from a single trauma or repetitive trauma.
A lack of exposure to adequate levels of physiological stress over a prolonged period of time (underloading) may predispose tendon to overload injury. The underuse of a tendon for a specific activity may not be able to cope with the increased demands placed upon it with a new or different activity.
Overloading of a tendon results in pain and swelling with associated decreased tolerance to exercise and various types of tendon degeneration.
A normal healthy tendon is brilliant white in color with a glistening appearance. They are dense connective tissue with organized collagen fibers in a parallel pattern (spaghetti in a package).
Tendinopathies are distinguished by a loss of the glistening white to a grey-brown appearance and collagen degeneration & disorganization (cooked spaghetti).
Healing of a tendon contains three stages: 1) inflammatory, 2) cellular proliferation, 3) remodeling. The inflammatory stage begins with formation of hematoma to stabilize the injury. Stage 2, proliferation of abundant collagens (type III/stiff) in a random disorganized fashion. Stage 3, remodeling occurs 6-8 weeks after injury up to 2 years. Remodeling involves the replacement of the stiff type III collagen with more resilient type I fibers and organize in a parallel direction to the tendon to normalize tendon stiffness and tensile strength.
In many years of clinical practice, I have treated 100’s of tendinopathies. One of the main behaviors I see in patients is that they tend to rest and address inflammatory stage. Unfortunately, that is the only management, and they typically end up in clinic for a chronic tendinopathy rather than an acute injury.
One of the most important things to heal a tendon is to apply gradual load (resisted training) to make the tendon more resilient to stress and strain. Resisted training can be performed isometrically, concentrically or eccentrically. A successful tendon loading regime has to be administered with proper positioning, dosage and recovery. This is where a skilled physiotherapist should be consulted for a proper prescriptive program.
What can you do to avoid a tendon injury (tendinopathy)?
- Proper sport specific warm-ups/ 5×30 rule: for every 30 min of activity, 5 min warm up to gently get joints moving and increase general blood flow
- Slow progression: gradually build intensity level of work and slowly increase exercise load. With resisted force, do not overload joints/tendons with large number of repetitions. Avoid repetitive use of same movement, mix up the workout during different days
- Proper posture and techniques: A referral to physical therapist for specific recommendations
- Prepare: begin building strength and flexibility in the muscles, tendons and joints you will be using ahead of time.
- Stop if pain occurs: Do not go with the No PAIN No GAIN mantra