Intro
Tendons are thin fibrous bands of connective tissue (collagen) that attach muscle onto / into bone.
They are often know for becoming inflamed and are commonly diagnosed when injured as tendinitis.
If you break this phrase down, it literally means tendon with inflammation (tendon-itis). However thanks to continued research we now know, that inflammation isn’t always necessarily present… tendon-isn’t, if you will.
Current thinking.
Tendon injuries were once thought to occur mainly at the site of attachment to bone, the enthesis. The Achilles’ tendon is one of the bodies largest and most commonly injured tendons. Due to its sheer size it’s allowed probably for more in-depth study. It’s been shown that there are actually different locations where injury can occur, the enthesis (as mentioned above) and or the mid portion. This is important as treatment and management differs dependent on location.
Rather than tendons being merely anchors for muscles to attach to bone, it’s been demonstrated that they in fact act as springs and store and release energy. More often than not Tendinopathy develops when the tendon cannot cope with demands being placed on them. They are to put it simple overused.
This is why we now often refer to tendon pain and injury commonly as; an overuse injury.
No need to over react
Cook and purdham have recently proposed a model which helps us to basket tendon injury into 3 stages
1 reactive Tendinopathy
2 tendon disrepair
3 degenerative Tendinopathy.
For the purposes of this short piece we will explain phase 1….
The reactive Tendinopathy
As soon as a tendon is overused or worked the cascade of changes occur. Changes within the tendon cells occur as a result of compressive and or tensile overload.
One thing I was taught to remember at university is that tendons “hate change and don’t handle the new tasks without kicking up a fuss”
Believe it or not, these changes are void of inflammatory products. The changes are also not seen when imaging as we mentioned; the changes initially occur in the tiny cells within the tendon.
Despite not being able to image this, the patients case history will often determine a diagnosis and which phase you’re at.
Typically, a reactive Tendinopathy will occur in a runner who has had a period of rest and then suddenly continued where they’ve left off.
Despite this being quite generic; there are a number of intrinsic and extrinsic factors such as age, gender, biomechanics etc.
The first stage of Tendinopathy is very short lived and it’s easy to go into stage 2 if no relative rest occurs. As a result of thirst changes the tendon will shorten and stiffen. Some say to protect it.
This may be what makes us feel the urge to stretch at times, but recent research has shown us that perhaps gently contracting the tendon (isometric or eccentric)
Here is a video demonstrating different types of contraction in the tendon…
Stay in tuned for part 2 where will find out what happens if one continues to aggravate the tendon With minimal rest…