Four steps to heal your tendinopathy

Tendons are wonderful structures of dense connective tissue, largely composed of collagen, that help connect muscle to bone. Its job is to help transfer force from muscle to bone. When tendons lengthen, they store energy that then gets released through a stretch-shortening cycle. This is that springy feeling you might feel when you load up for a big jump. Tendons allow us to be adaptable in movement. 

What is tendinopathy? Tendinopathy is an injury to the tendon or paratendon (the outer casing of a tendon) that is aggravated by mechanical loading which results in a tendon being less capable of sustaining repetitive tensile loading. It’s categorized as an overuse injury. The primary cause of tendinopathy is excessive load beyond the tendon’s usual capacity. Imagine you are carrying one grocery bag into your house, which you’ve done many times before. You decide to host a big party tonight and now suddenly you carry 50 bags at one time into your home. You get it done, but the unaccustomed stress aka the sudden increase in number of bags has left you sore and tired. You decide to do the same thing the next day, and the next day. You’ve now chronically overloaded yourself past your usual ability and are in a large amount of pain because of it. In this scenario, you are a tendon, and the 50 grocery bags represent an excessive load. This type of experience is what leads to tendinopathy. This can happen from a sudden increase in training, a major change in training, or participating in an activity without any prior experience in that activity. Tendinopathy is a reactive inflammatory process that can lead to permanent degeneration if not checked. 

It can be a simple injury to treat, and many people have pain relief with conservative management. Treatment includes pain management, progressive mechanical loading, biomechanics optimization, and a graded return to activity. A great place to start if you are experiencing tendon-related pain is to find a local physical therapist to coach you through a unique treatment strategy for you. In general, here is an outline of what you might expect. 

1. Pain reduction and load management
   1. This stage includes the use of isometric exercises to heal the tendon and avoid positions of compression or aggravation.
   2. Patellar tendon example: 60-second (non-painful) wall sit 5x with a 1–2 minute rest between reps and avoiding deep squats and plyometric activity.
2. Transition into heavy resistant training
   1. This phase is important because it helps rebuild the capacity of the previously injured tendon. If we use our shopping example, you are training to handle those 50 grocery bags on a regular basis in this phase.  
   2. Patellar tendon example: heavy weighted goblet squat progressing from 15 to 6 reps over time for 3-5 sets, increasing weight over time. 
   3. Please note that this phase only works if the mechanics of the movement performed do not compromising the structural integrity of the tendon. This is where a LYT yoga practice would come in handy! LYT yoga teaches smarter, safer movement patterns that teach us to be more conscious in the way we load our bodies. This makes for some happy tendons ☺. 
3. Plyometric training
   1. This phase is where we increase the volume and intensity placed on the tendon to retrain tendon adaptability and refine the stretch-reflex response tendons were made to do!  
   2. Patellar tendon example: adding jumps and hops into your daily LYT practice. 
4. Return to activity
   1. Now we put the tendon to the test in a graded return to activity program specifically laid out to also include the previous phases for tendon health maintenance while returning to the desired activity. 
   2. Patellar tendon example: a walk: run return to run progression 2 days per week, heavy strength training 2 days per week, 1 total rest day, isometric exercises as needed, and a regular yoga practice to continue building better movement habits. 

Tendons are great structures in our bodies that allow us to be adaptable in our movement patterns when trained appropriately. They are easily made grouchy when care is not taken to load them appropriately. This includes chronically underloading them! It’s a principle as old as time. Tissue responds to the demand that is placed on it. If we do not regularly place an adequate load on these important structures of our body, we lose the adaptability that makes the human experience more enjoyable. Don’t we all want to maintain the ability to play with the dog, run with our kids, and dance just for the fun of it? Following the principles of tendon health explained in this article will help us do just that ultimately so we can live long, pain-free lives with better movement and happy tendons. 

Happy movement and love always, 

Thalia Wynne, PT, DPT, AT

@thalialovee 

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Image: https://aidmyachilles.com/achilles-tendonitis-injury/achilles-tendon-anatomy-function.php