Tendinopathy, or tendon pain, is a term that refers to a disease in the tendons. The tendons are fibrous connective tissues that connect muscle to the bone. Tendinopathy is often characterized by tenderness to touch and pain. Gluteal, patellar, achilles and hamstring tendinopathy are examples of lower limb tendon pain. Effective strategies for tendinopathies include ongoing, exercise-based regimens that slowly build up muscle power and tendon strength. In recent years, there has been significant advancement in how we understand and treat lower limb tendon injuries. Professor Jill Cook, the world’s authority on tendon rehabilitation, gives a nice overview of what not to do if you have lower limb tendon pain. The ten points are highlighted below.
- Resting Completely. The old adage of “use it or lose it” applies to tendons. Just resting decreases the ability of the tendon to take the load. You have to reduce the load to the level that the tendon can tolerate and then slowly increase the tolerance of the tendon to take the load.
- Passive Treatments. Treatments that do not address the need to increase the ability of the tendon to take are not usually helpful in the long term. Treatments like electrotherapy and ice will only temporarily ameliorate pain, only for it to return when the tendon is loaded.
- Injection Therapy. Injection of substances into the tendons have not been shown to be effective in good clinical trials. Do not use them unless the tendon has not responded to an exercise-based program.
- Ignoring Your Pain. Managing the load on your tendon pain is a way of telling yourself that the load is too much. Reduce the aspects of training that are overloading your tendon, like running or jumping. On a very irritable tendon, isometric exercises have shown to decrease pain by 50 percent.
- Stretching Your Tendon. Adding stretching to most tendons only serves to add compressive loads that we know are detrimental to the tendon.
- Managing Your Tendon. A painful tendon is one that is telling you that it is overloaded and irritated, therefore adding further insult by managing it can actually increase your pain.
- Being Worried About the Images of Your Tendon. Don’t worry about MRI or ultrasound findings. There is evidence that pathological tendons tolerate loads, especially when you gradually increase the load.
- Being Worried About Rupture. Pain is protective of your tendon; it makes you unload it. Most people who rupture a tendon have never had pain before, despite the tendon having substantial pathology in it.
- Taking Shortcuts with Rehabilitation. The tendon needs to build its strength and capacity. Things that are promised of cures often give short-term improvement, but the pain comes back.
- Misunderstanding What Loads Are High for Your Tendon. The highest load in your tendon is when you use it like a spring, like when you’re jumping or sprinting. Other loads are low load for a tendon, although they have a beneficial effect on the muscles.
Get Ambas, P.T., is a physical therapist at MidMichigan Health.