Stay in the Game: Tackling Tendinopathy for Athletes

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The Sports Injury Clinic

Ash Annavarapu

October 6, 2023

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As the sports season draws to a close, it becomes crucial to prioritize our physical well-being and minimize the risk of future injuries. While it's an excellent opportunity to recuperate and rest, we should also keep our eyes on the upcoming pre-season and ensure our bodies are in the right condition. In this blog, we'll delve into tendinopathy, a common injury, and explore what it is and how to mitigate and rehabilitate it.

What is a tendinopathy?

The definition is the name itself- an injury that has occurred in the tendon itself. Some people can mistake it for an acute tear i.e., a hamstring tear, however this is not the case. A tendinopathy is a response to increase amount of load which can cause some disruption and dysfunction in the tendon itself. 

How does it occur and where?

As mentioned above, it occurs when there is an increase in load or activity demands than compared to normal. For example, a common occurrence is when individuals are training for a marathon and they have increased the amount of running loads that they have been doing. Another example is when athletes go into preseason without having any sort of load management during the off season. They go into preseason with no load training, causing the body to not be able to handle the load at the tendon.

With this increase in load, there is an intracellular abnormality in tenocytes(tendon repair cells), disruption of collagen fibre and therefore an increase in non-collagenous matrix which cause a tendinopathy.

Tendinopathies can occur in each body part. The most common areas that come into the clinic are:

  • Patella tendinopathy
  • Hamstring tendinopathy
  • Achilles tendinopathy

What all these structures have in common is store and realise substantial number of tensile energies. A healthy tendon is white in colour. The remodeling of a tendon takes a longer time due to the oxygen consumption being lower. It is about 7.5 time lower to remodel tendons and ligaments compared to muscles. 

 

How does it present?

Can occur as pain at the start of activity then disappears once warmed up. Then comes back when cooling down. The pain is localised around the tendon junction. In early stages the pain can be quite sharp whereas the chronic stages get a bit duller ache.

Acute reactive tendons:

  • Young individuals 
  • Acute overload
  • No prior history

Degenerative tendons:

  • Small but recognisable load increase which has caused pain.
  • Middle age older adults
  • Tendons are dysfunctional due to sedentary lifestyle

Symptoms look like:

  • Atrophy of one side (muscle bulk on one side)
  • Swelling
  • Range of motion limited
  • Loading the structure to figure out pain- SL calf raise for Achilles tendinopathy.

 

How to treat it?

It takes a long time for a tendon to settle down. These are just steps to help settle the symptoms down and then continue to build and strengthen:

Reduce pain

  • Isometrics are a great way to help with symptom management. Isometric are described as tightening or contraction of a specific muscle group. In these exercises we are not changing muscle length as such. For example, Single Leg calf raises for an Achilles tendinopathy with holds of about 20 seconds to start with is a great place to start.
  • Stretching is an important part of stopping in this stage. Due to the tendon behaving like a spring, it stores and release energy when stretched and therefore in this acute stage it is important not to stretch the tendons out.

Improve strength

  • Once the pain has settled down, we build into some heavy slow resistance training. This is just a step into going into your functional training but will help with building a good base. Additionally, this is to help promote changes to the tendon and build the capacity of the tendon to load.

Energy storing loading

  • This is where increase power training (plyometrics), building functional strength and getting back to training loads is important. This is just a step into building back into return to sport.

Return to sport

  • Hopefully following these steps, a return to sport and competition is done with no issues. This stage includes doing training drills specific to the sport and the person is tolerant to full training with no pain.

For personalized treatment, it's best to consult with a physiotherapist to develop an action plan.

Book online now or call or reception team on 9783 9990.

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