Tendon injuries are complex injuries which can take a long time to heal. To date we are unsure as to exactly why tendon tissue fails in the manner that has been outlined and why tendon cells take such a long time to heal. It is because of these reasons, injuries to people’s shoulder, elbow, achilles, patella (knee cap), adductor (groin), hamstring and gluteal (buttock) tendons can become chronic ones.
Common presentations of tendon injuries and their management
The location and presentation of the injury will be outlined. It is common for people with tendon injuries to report minimal pain during activity but worsening pain once the activity ceases. This will unfortunately worsen with persistent activity.
All these injuries require activity modification coupled with specific exercises (hopefully eccentric as outlined previously). Management for each injury will be described briefly and any exercises mentioned will need to be prescribed specifically by a physiotherapist. Incorrectly performed exercises or inappropriate amount of exercise will most likely worsen the injury.
Manual therapy techniques such as massage, trigger pointing and dry needling to release/loosen specific muscles around the tendon can also help with overall management of these conditions.
Tennis elbow or lateral “epicondylitis” affects the extensor tendon of the forearm. It presents as pain on the outer part of the forearm and commonly acute tenderness over the outer bone of the elbow (lateral epicondyle) usually after repetitive movements of the wrist and fingers. Examples of when people develop tennis elbow are:
- over gripping/clenching with work
- cleaning
- lifting
- cooking
Exercises for this condition include forearm stretches, eccentric wrist curls with resistance and possibly strengthening of the shoulder on the affected side.
Rotator cuff tendon problems are possibly the most common of tendon pathologies. These tendons attach to the front of the shoulder and commonly fail through overuse. Though sports like tennis, baseball and swimming often lead to shoulder tendon injuries, people frequently complain of pain resulting from simple activities of daily living. Once injured, pain results when:
- lifting
- putting on and taking off clothes
- reaching up or to the side
- lying on the affected side
Management of such injuries usually requires biomechanical correction of movement and strengthening of specific muscles surrounding the shoulder.
Achilles tendon injuries can present as pain on the achilles tendon which originates from the back of the heel extending 10 to 15cm up towards the calf. Its function is to transmit the force of the calf muscles it is attached to thus propelling the body forward. It is usually tender to touch and often the injured will complain of pain when rising onto their toes. A thicker tendon coupled with weakness may result with chronicity. Management involves assessment of foot mechanics and footwear with the main exercise being eccentrically biased heel/calf raises.
Patella tendon injury also known as “jumper’s knee” presents as pain over the patella tendon which is located below the base of the knee cap. It presents similarly to the achilles tendon but in this case it transmits the force of the quadriceps (frontal thigh) muscle thus allowing for explosive activity. Footwear and foot mechanics are similarly important factors in management of the condition. Eccentrically loaded squats are the primary exercise. Achieving better pelvic/hip stability coupled with improved lower limb flexibility are often also important with patella tendon injury management.
Adductor (groin), hamstring and gluteal (buttock) tendon strains are commonly associated with imbalances in lower limb strength from right to left. Their presentations can be varied and hence more complex. For these conditions, pelvic/hip stability (core strengthening) will be vital in achieving a good outcome. The exercises for these tendon injuries are also difficult to describe and quite varied. Thus it is best to ask for advice from your physiotherapist and have the exercises shown correctly.
Lastly, tendon injuries are annoying injuries which can last for long periods of time even though the part/joint involved does not looked injured. It is usual for the pain to be insignificant to start with but increase with persistent aggravating activity. Most importantly, seek advice from your physiotherapist or medical physician for best possible care of the injury.
