Tendon Trouble?
YOUR ESSENTIAL DO’S AND DONT’S FOR BEATING TENDINOPATHY
Imagine this scenario: you recently became motivated to get back to the gym and get in shape. You are determined to be dedicated this time and build a routine that involves 4 days in the gym and 2 days of jogging. All is going well – you are consistent and enjoying exercise again… until a nagging pain in the front of your knee starts creeping up on you. It feels okay once you get going in your run or workout, but the rest of the day it aches just walking around. At first you think you should be stretching more before your runs, but even with this change, the pain is becoming worse.
You look to Google and YouTube and find exercises that encourage “knees over toes” strengthening, but you find that these significantly increase your pain. You feel discouraged because you can no longer continue with your new-found commitment to getting in shape. Does this situation sound familiar to you?
This is a very common pattern that we see as physical therapists. This story typically leads us to a diagnosis of a tendinopathy, or pathology of a tendon. In this scenario, the tendon in front of the knee was loaded too much too fast. This initially creates microscopic tears and inflammation referred to as tendinitis. As this progresses, the tissue has difficulty repairing itself, leading to cellular changes and release of pain mediators. At this point, we refer to it as tendinopathy.
Oftentimes our initial thought is to stretch, however, this can actually make matters worse, as this is an increased strain on an already unhappy tissue. Instead, we have to find a point of entry to load the tendon to help reorganize the collagen and tissue matrix, reduce pain levels, and rebuild a more robust tendon ready to take on the demands of your new-found joy in strength training and jogging. Finding this entry point is key.
As physical therapists, it is our job to meet the tendon where it’s at. We lean on isometric exercises in this phase. These are exercises where the muscle is engaged, but it does not move through a range of motion. For our knee example, this may look like a wall sit, holding for 30-40 seconds for 2-3 rounds. Once the tendon is out of the highly irritable stage, we then get to move into the more challenging exercises similar to the “knees over toes” movements that were once too aggressive. Finally, we will help build into quick stretch activities that more closely resemble the force that the tendon should be ready to take on for activities such as running and jumping.
Tendinopathies can be very frustrating, as tendons are slow-healing in nature. We understand how discouraging it can be to have to slow down the activities you were feeling so motivated about, but a good PT will help guide you through the process to be specific to your symptoms and irritability level, modify your current routine to keep you moving, and build a plan to not only get you out of the acute phase, but create a more resilient and healthy tendon. Below is a quick list of Do’s and Dont’s if you find yourself dealing with tendon pain:
TENDINOPATHY DONT’S
-DON’T aggressively stretch the tendon
-DON’T continue your activity levels while pushing through increasing pain levels
-DON’T jump to different exercises you find online
-DON’T give up on the activity you were once excited about
TENDINOPATHY DO’S
-DO give the tendon relative rest from the aggravating activity
-DO perform a graded rehab program starting with isometrics and progressing back into the demands of your activity
-DO ensure you are getting adequate sleep, nutrition, and managing stress levels
-DO use modalities such as shockwave therapy to support the healing process
-DO consult a PT to build and guide you through a consistent plan specific to your goals
Ready To Tackle Your Tendinopathy?
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ABOUT H.I.R.T.
We are passionate about helping you move and feel your best. Whether you’re just out of surgery or dealing with a nagging injury, our dedicated physical therapists perform detailed evaluations to be identify the exact cause of your pain.
Through personalized programs and care specific to your needs, at H.I.R.T. your recovery is our focus and we’ll do everything to get you back to what you love.
