What is a tendon?
Tendons are dense (ie tightly packed) connective tissue that connect muscle to bone. For the meat eaters out there, tendon is the silvery stuff you see on a leg of lamb. (Sorry to the vegetarians and vegans out there!)
An easy to visualise tendon in our body is the Achilles tendon, which attaches our calf muscle (or gastrocnemius for the “aficionados”) to our heel bone. Our achilles allows our super strong calf muscles to create force for us to hop, jump, run and do plenty more.
So…tendons main role is to transmit load. That could be pushing loads, jumping loads, landing loads, running loads you get the drift….
Why does my tendon hurt?
Generally, tendons become painful when they have either been underloaded or overloaded. Underloaded is less common and usually means you’ve been on bedrest or in a plaster cast, then started moving again. Let’s focus more on the really common reason for tendon pain – OVERLOAD!
What is overload?
Overload is a common reason for injury and really just means you have done something that the tendon cannot tolerate. It could be that you upped the weights too quickly in the gym, started running 7kms when you have never run before, or were doing something that was unusual or in an awkward position for too long (ie time can be a load) for eg, lifting your arms to paint all your ceilings at home and getting a shoulder tendinopathy.
The term tendinopathy just means “pathological tendon” – I know, I know….it’s not nice sounding is it? These tendon pain presentations used to be called “tendinitis” until around the mid 90’s, when some clever researchers found that there was no inflammation present in tendons when they were sore….and given the suffix “-itis” means “presence of inflammation or inflamed” it didn’t make sense to use that term anymore and medicos around the world started switching to now accepted term “tendinopathy”.
Sometimes I feel like my tendon pain is gone, but then I wake up the next day and the tendon pain is really sore. What is this about?
This is an interesting feature of tendon pain, which is quite unique and that’s the fact that tendons exhibit a 24-hour pain behaviour. In other words, if you overload your achilles tendon by running a bit too fast/too soon/too long, it may not necessarily hurt WHILST you are performing the overloading task. It might show up the next morning when you limp the first few steps out of bed. Sometimes this can make tracking your tendons behaviour difficult and you physio may suggest using a pain diary to help with this.
What do I do about my tendon pain? I’ve tried painkillers and anti-inflammatories and they don’t work?
Ah…yes…this is something our patients say to us all the time. Recall earlier we said there was no sign of inflammation in tendons that are sore? Well, for that same reason, anti-inflammatories will have no effect. So, let’s jog along.
The exact mechanism by which our brains perceive tendon pain has yet to be discovered, so it’s tricky. Tendon pain doesn’t seem to arise from the same places that muscle and joint pain does, so painkillers like paracetamol and codeine don’t work either. This is important as pain killers can be addictive, so you have to be careful when using them.
Should I ice my tendon? It looks swollen.
Good question. The short answer is heat or ice don’t really help.
The long answer is – that swelling you see in your tendon has been found to be water and not true swelling, like when you sprain an ankle. Researchers believe your body secretes water into the tendon when it is aggravated in order to protect it. We can see this water from the outside and it looks like classic swelling, hence the misconception. So icing it won’t get the swelling down as one might expect.
So what does work for tendinopathy?
Over the last 30 years, lots of research has gone into trying to fix tendinopathy pain.
Cortisone? Nope. Makes it worse.
Surgery? Nope. Makes it really bad. (Though surgery is crucial if you tear certain tendons…but that’s a different story.)
Pain killers? Anti-inflammatories? Nope. Nope. For the reasons discussed above.
All the research in the last 30 years has shown only one thing really works with tendinopathy – and that’s EXERCISE.
Ah….but not just any exercise. You might recall earlier in this blog that exercise can aggravate tendons. So it can’t just be anything…it has to be graded, specific exercise as designed and prescribed by your physio.
What exercises your physio chooses all depends on how you present and which tendon you have aggravated. What your usual loads are also comes into account, and whether any muscle weakness is present. So a lot of thinking goes into any exercise program your physio gives you.
We find here at Active Physiotherapy Newtown and CBD, that our tendinopathy patients respond usually really quickly to our treatments. In some cases, we have had patients with “hip bursitis”, where there is a mild bursitis and a gluteus medius tendinopathy, who haven’t been able to sleep lying on their sides for years. Once we have started treating them, they report being able to sleep better on the very first night!
Most patients, within the first few weeks, are reporting they feel much better.
Once you’ve started feeling better, we then would look to return you to your chosen sport or activity as soon as possible, without aggravating the tendon again. This is sometimes difficult to navigate, and your friendly physio will help you with this.
If you think you might have a tendon issue, and have tried to use ice or painkillers and wondered why it hasn’t helped, now you know why! If your tendon problem is bothering you when you exercise, if you’re waking in pain – CALL US TODAY. Let our expert team start getting you moving better and feeling better.
Until next time,