Tendonitis and tendinopathy are a common complaint seen within the physio clinic. Tendons can get all angry with you if you load them up too fast or too soon ( think training for only 2 weeks before the City to Surf and then hitting that race day a little under prepared), if you do not allow enough rest between exercise, or even if your postures are not ideal and joint alignments not too flash. Age, and for women, menopause, can all be factors that cause our tendons to become inflamed.
But don't despair, that Achilles tendon, rotator cuff shoulder tendon, tennis elbow tendon or knee cap tendon can all adapt back to being strong, not inflamed and ready for the work you wish to put though them. This is called tissue adaptation, and it is what keeps our bodies sometimes breaking down, but then allowing for healing too.
The vicious cycle
"Why, in the first place did my tendon go all silly on me?"
"OK, if I rest from that triggering activity, will it get better?"
"Sure, but if it is only rest you do and you go back to the same triggering activity, what do you think may happen?"
"Hmm, I see a cycle developing here."
Tissues, like your tendons, need to withstand the pulling and tensile forces you put though them. If they are overwhelmed and cannot, then trouble starts a-brewing. To improve their ability to withstand these forces, you must stimulate them to become stronger, to thicken, to be able to absorb the forces. We want and need them to adapt, and to do this, you must challenge them. And yes, this means exercise, and even when they are still inflamed and you are 'resting' from the triggering activity.
The right kind of tissue adaptation
So, what is the right exercise to do when your tendon needs strengthening but is also going through a rough patch of inflammation? Tendon loading! Your amazing physiotherapist should know all about this and would be there to set you up on a targeted program just for you and your unhappy tendon. However, here are the basics:
- When you exercise a muscle, you also exercise it's tendon. By targeting the muscle very specifically, mindfully and with a few little rules, you can achieve a stronger tendon while you are resting from your sport and any chance of ongoing inflammation.
- Exercising an inflamed tendon, may make it hurt a little, but this is often what we are after. What?? A little pain at the time, with no lingering issues or inability to go about your usual daily activities is perfectly acceptable. We use the pain scale out of 10 for this one, and would recommend that pain levels with your tendon loading exercises of up to 3/10 is OK. Anything more, or if it's stirred up for days after, then, yep, the tendon is not happy with its little workout. It often takes a little adjusting of your exercises to get it right.
- Exercise to fatigue. When you are isolating a muscle like you do with these tendon exercises, we want you to achieve that burn, quiver, or "I just can't do another rep" feeling in the muscle. Playing around with the weight or load you have for your contractions help you to reach this point without having to do 200 reps!
- Slow controlled movements work best. Really demanding a long 'time under tension' of your tendon will yield great results, especially in the eccentric or lowering phases of your movement with gravity.
- Offer a progressive strengthening program, increasing the weights as weeks tick by and fatigue is harder to reach. Do keep in mind the 3/10 pain levels here. You do not want to go backwards. However, on a positive note, healing will take 6-8 weeks, and inflammation levels will be decreasing if you are dong everything right.
- Offer a graduated return to sport and that triggering activity. Have you tried some sport specific activity that tests the tendon, but not as a full blown 2 hours tennis match with your tennis nemesis? Go for a hit up against the wall for 10 minutes, softer shots, not as long a time to stress your tendon. How did it go? How was the tendon soreness after? All good? Increase your time at the wall. Same goes for a return to running with an Achilles, patella or hamstring tendinopathy. Jog/walk programs are the best at gradually loading up that tendon that got angry with all your running prior.
So, don't let a tendon injury beat you down. There is plenty you can be doing to make it a better and stronger tissue. I bet that this 'new' tendon of yours may be even better than the one you had before the injury.
