Pain arising from a tendon is common especially in the sporting population. Although we are understanding more and more about the injury process and subsequent healing, they can still remain a challenge to treat. They are slow to heal, and if not diagnosed correctly and addressed and early on, they can be a persistent and nagging injury that can re-occur and prevent you from being active.
Common tendon injuries we see in clinic include:
- Achilles tendinopathy (heal pain).
- Proximal hamstring tendinopathy (back of the thigh/buttock pain).
- Rotator cuff impingement and tendinopathy (shoulder pain).
- Gluteal tendinopathy (lateral hip pain).
- Lateral epicondylopathy (elbow pain).
There are a few important things to remember when it comes to the treatment of tendon injuries.
- Get the correct diagnosis: seems obvious, but this will determine the treatment and rehab to follow. A good history and physical exam is the key! Imaging is not necessarily the answer and should only be used a one piece of the puzzle. In fact, studies show that a large percentage of the population that are symptom free have evidence of tendon injury ie. partial and even full thickness tears on MRI which means we can’t simply rely on this alone to be sure we are treating the right area.
- In the early “reactive phase” when the area is still very painful it is important to avoid the activities that aggravate and overload the tendon. This may be stopping running for a period of time, avoiding sitting etc. Anti-inflammatory herbs or medication can also be useful in this phase as getting the pain under control is the first priority.
- As much as you might feel like it, tendon injuries should not be stretched! If you stretch a tendon injury too much you are likely to aggravate it.
- Strengthen the area. This should be done gradually and guided by your practitioner. Strengthening should be simple in the early stages, and progress to exercises that are similar to the sport or activity that you are trying to return to. There is no single rule when it comes to the sets and reps you should be doing as everyone is unique in their injury and healing time. However, a good guide to know you’re doing enough is… 1) If you are feeling pain free with no movement restriction the day after you do your exercises you are probably not doing enough, try increasing the repetitions in each set. 2) If you are feeling significantly aggravated and stiff the next day then you might be doing too much or the exercise is to strong. 3) If you are feeling mildly tender and a little stiff, then you’re probably doing it just right, and progress to more repetitions or an increase load when you lose that sensation.
- You should expect to be in it for the long hall. Many tendon injuries, especially in the lower limb take months rather than weeks to heal. For example, a proximal hamstring tendinopathy typically takes 6-8 months or even up to a year to get back to full activity. This doesn’t mean you’ll be in pain for that long, but it does take a while for the area to rehabilitate and if you go back to full sports too early, there is a high rate of re-injury.
- Get the surrounding structures checked and treated too. It’s important for the whole kinematic chain to be functioning as best as possible to allow a proper recovery and prevention of other injuries!