Tendinopathy – Overuse Injury!
Tendon health is very important for the longevity of any athlete who is competing at any level where there is repeated or significant force placed through their joints. Many athletes and recreational athletes will at some point in their careers experience pain in one of their tendons that may prevent them from competing at the intensity in which they would like, or competing at all. There are several different types of tendon injuries that can occur but the most common is caused simply by overuse.
When this happens acutely, as in during one day of vigorous exercise, it is called tendonitis, meaning inflammation of the tendon. In medical terminology whenever there is an -itis at the end of a word it is referring to inflammation. Most people have heard this with conditions such as tonsillitis (inflammation of the tonsils), appendicitis (inflammation of the appendix), conjunctivitis (inflammation around the eye), etc. In the same manner a tendon can become inflamed which presents signs of heat, redness, and swelling around the area. While this can happen it is not as common as most people might think.
The more likely presentation of tendon pain is from chronic over usage over time where the tendon experiences consistent microtrauma that builds up over time to finally present as macrotrauma and causes a pain experience. In this case a tendon will present with tissue dysrepair where the fibers that make up a tendon, collagen, are not in the nice parallel formation that they normally are and will have a haphazard organization to them. This not only decreases what is called the load capacity of the tendon but can also cause pain as your body perceives load through the tendon as damaging. The term for this type of tendon pain is tendinopathy.
Many athletes will experience this but the presentation will vary depending upon the region that is overused in their sport. Common terms associated with this type of chronic overuse injury are golfer’s elbow (medial epicondyle of the elbow), tennis elbow (lateral epicondyle of the elbow), jumper’s knee (patellar tendon of the knee), etc.
In order to treat this type of injury you will need to give the tendon the right stimulus in order to induce it to remodel properly and establish the nice parallel collagen fiber alignment. Many research studies have shown that the best way to allow this to occur is the use of slow heavy tensile load through the tendon. The best way to do this is with the use of eccentric contractions; where the muscle and tendon fibers are slowly lengthened under a load like when slowly lowering an object down as opposed to concentric reactions where there is a shortening of the muscles as is seen with lifting something up.
Eccentrics have been shown to be the best way to provide slow heavy load because it allows for the most control of such a force that the tendon needs to remodel. This should be performed very slowly as in over 8-10 seconds while going through the full range of motion. WIth this exercise a mild amount of pain is expected and acceptable. The key with this type of muscle activation is lengthening the muscle tissue under tension. Think of picking a heavy object out of a truck and slowly lowering it down to the ground and then trying to pick it up and put it back in the truck with the same controlled speed, a lot harder.
Jumper’s knee, or a tendinopathy of the patellar tendon that connects the kneecap to your lower leg bone, the tibia, is a very common type of tendinopathy in any running, jumping, or cutting athlete. An exercise that is a great way to give this tendon the slow heavy load it needs to remodel is the Spanish Squat, check the link above. This exercises allows for a smooth controlled contraction with the feet in contact with the ground like which occurs during most athletic motions. On the opposite side of the knee joint are the hamstrings and a great exercises to produce the same effect is the Nordic Hamstring Curl, check the link above. So if you are having some pain in the front of your knee and believe it is an overuse injury of the tendon that is causing the pain give these exercises a try and see if it can reduce your pain and increase your performance.