Tendon overuse pain 

With the Melbourne Marathon fast approaching and the weather improving we are starting to see more runners out pounding the pavements. Because of this I thought it would be good to address the topic of tendon pain. Tendon overuse injuries or pain account for a large proportion of a sporting clinician’s case load. In other words, we see it a lot. More specifically for runners, Achilles tendinopathies.

Typically, tendon pain tends to be worse on the morning after exercise or activity, is usually pain free at rest, becomes painful with use, and is painful to touch on the effected tendon.

During exercise or training you might experience pain with the first few steps, then warm up with activity to the point of comfort, then it may or may not reappear towards the end of training.

Tendon pain can be broken down into three categories:

1. Reactive Tendinopathy: Cells within a tendon respond to increases in load (i.e. running) and become activated. These activated cells can then produce pain receptors, and you as the runner start to feel acute pain in the tendon. These cells need calming down, in other words, rest. If these cells continue to detect tendon overload, they produce certain proteins which swell the tendon. This then leads into phase 2.
2. Tendon Disrepair: Increases in the aforementioned proteins causing the tendon to swell eventually leads to the breakdown of the connective tissue matrix. Matrix breakdown allows for more space for blood vessels to grow into.
3. Tendon degeneration: Cells become quite passive. This phase is characterised by a “grumbly tendon”. It can be a little sore in the morning but usually settles down ok. People with tendons in the degeneration phase don’t usually present as often to physio as their pain doesn’t seem to bother them too much day to day.

The best management for the “reactive” tendon is relative rest, ice and commencing an isometric loading program which your physiotherapist can help you with. Anyone who has suddenly increased their load or training volume can experience this pain, but when identified and addressed early, this type of tendon pain can be relatively easy to settle down.

The disrepair or degenerative tendon rehabilitation requires a little more patience. This tends to be a step-by-step process whereby you would commence a weight based strength program guided by your physiotherapist, work towards gaining full range of motion at the effected joint, and then graduate through a guided walk/jog program. From here your physiotherapist would then introduce power/dynamic loading prior to progressing to sport specific tasks and eventually a full return to sport.

If you are looking to get back into running, or are starting to experience the above described pain, get in touch with one of our physiotherapists and we will help guide you through the process!

References:

Brukner, P. (2012). Brukner & Khan’s clinical sports medicine. North Ryde: McGraw-Hill.

Cook, J. (2011). Tendinopathy: no longer a ‘one size fits all’diagnosis.

Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine, 43(6), 409-416.