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Tim Rowland Athletic Performance
HOW TO MANAGE TENDON INJURIES
One of the most common injuries suffered by athletes and gym-goers is tendinopathy (more commonly known as tendinitis however this term is technically incorrect as 'itis' means inflammation and this is not thought to play a big role in most tendon issues).
Tendinopathy is an overuse injury of the tendon that results in degeneration of the tendon's collagen (main structural component of the tendon). It is believed to occur due to too much stress being placed on the tendon with not enough time for it to recover/adapt positively to this stress.
Common areas for tendinopathy include the patellar tendon (knee), Achilles tendon, hamstrings, biceps, and wrist flexors/extensors (which attach proximally on the inside and outside of the elbow, respectively). Often the pain from tendinopathy is worse in the hours after exercise or the next day rather than during exercise, where they tend to 'warm up'/become less painful as exercise continues.
***One of the most important things to understand about these injuries is that COMPLETE REST DOES NOT HELP.***
This is very different to most other injuries which tend to improve over time with rest. Tendons on the other hand MUST BE LOADED TO IMPROVE. The tricky part is getting the amount of loading right! Too much load and they often flare up and pain increases. Too little load and they don't get better.
So here's a guide to tendon loading that is both based off the research and one that I've found works well in my clinical experience.
*Note - this does NOT have to be followed like a bible; there are many different ways to load tendons, and some people will respond better to certain methods than others - every person/case is different! This is just one protocol that I've found has worked well for myself and my patients.
It can be applied to tendinopathy in any area of the body. You just need to pick an exercise where the muscle/tendon in question is the main one being worked.
Here it is!!!
1. Start with isometric holds in the mid range position for whatever muscle/tendon is the issue (e.g. Quarter squat for patellar tendon). Hold for 30-45 seconds. Do 2 sets, twice a day (e.g. 2 in the morning and 2 in the evening). Use a weight/resistance which allows you to do the hold with pain less than a 3/10. Don't push through the pain any more than that. Do this for a week or so and increase the resistance as able within those pain limits.
2. Progress to eccentrics. Start at the top of the movement/in the shortened position and lower over 5-6 seconds then help up/do the concentric with the other arm/leg. Do this for 1-2 weeks and progress weight as able within the same pain limits (<3/10).
3. Progress back to normal eccentric and concentric lifting but using higher rep ranges (>12-15 reps). Slowly increase the weight/lower the reps over time as symptoms allow, keeping in mind to monitor how you pull up the day after making adjustments to the loads used.
-Pull up really sore in the tendon? Probably best to regress a bit and build back up.
-Pull up with a bit of awareness/minimal pain? Try the same loading again and see if it feels better the next time.
-Pull up absolutely fine? Green light to progress!
4. Final stage is returning to plyometrics, if this is a part of your regular training or is needed for your sport. By no means do you NEED to do this type of training for tendon healing if it's not. Before starting plyometrics I personally think it's a smart idea to reach pain-free strength levels within 10-20% of what they were pre-injury, so that the tendon has re-established good load tolerance. This is important as plyometrics are the most stressful type of activity for the tendon.
Throughout this process, avoid or modify your gym exercises that cause more than a 3/10 pain. For example, for patellar tendinopathy try switching from normal back/front squats to box squats or low bar back squats, or from walking lunges/split squats to reverse lunges.
Following this process should help clear up most tendon issues. Tendons are annoyingly slow to work with but normally respond well to sensible load progressions.
I would also recommend thinking about what may have contributed to the injury in the first place so that it's less likely to come back (which unfortunately happens all too often with tendinopathys).
Most of the time it's a tendon load management issue caused by either:
-too rapid a build up in training volumes
-poor technique that places abnormally large stress on the tendon in question, e.g. Squatting with excessive forward knee travel well past your toes for patellar tendinopathys; or jerky/bouncy movements at the bottom of the exercise when the tendon is being compressed
-not having enough variety in your training program (e.g. If you've back squatted heavy for months on end maybe it's time to change up the exercise or rep range)
