5 Tips for Tendon Troubles

Tendon problems can often be frustrating, they often prevent you from doing the things you enjoy in life. Getting the right advice as soon as possible can be key to getting you back on the road to recovery and doing the things you love.

The 5 most common areas that tendon problems occur are:

1. Achilles Tendon (at the ankle)
2. Patella Tendon (at the knee)
3. Gluteal Tendon (at the hip)
4. Later Elbow Tendon (at the outside of the Elbow)
5. Hamstring Tendon (at the top of your leg near your sitting bone)

Here are IPRS Health’s 5 top tips that can start you on the road to recovery for any of the above tendon problems. 

1. Reduce or stop aggravating activities

This is where lots of people can go wrong, in the initial stages of pain if you keep pushing through it you may notice the pain gets worse. This is a big sign that a short period of rest from the activity that is painful is needed. This can be hard when the activity may be a key part of your work or a sport you enjoy but having a small break now is better than having a longer break further down the line. Recognising when something is irritating your tendon is important. The main thing to look out for is pain that continues beyond the activity or when doing an activity becomes increasingly painful at the time. This does not mean complete rest is best, find ways to stay active without involving the tendon or causing pain. Getting this stage right will give you a good platform to recover from and can shorten your recovery.

 2. Find your tendons sweet spot

After a short period of offloading (resting) the tendon, you need to find your tendons load tolerance, this is the amount of activity/ exercise you can do without causing increased pain in your tendon. When you have found your load tolerance you can then build up from this slowly. The irritability and pain in your tendon should help guide you on how much you want to load or stress it. This is all about getting the right balance between rest and load, finding your sweet spot. Too little load and you risk the tendon getting weaker, deconditioned and less tolerant to activity. However, too much load can cause further irritation and problems with the tendon. In this phase of your recovery you need to prioritise your recovery and create the right conditions for your tendon pain to improve.

3.  Understand the timeframes

Building up your tendons tolerance to activity (load) can be a slow process and requires you to be patient. If you try and progress this too quickly you risk causing a flare up of your symptoms and having to take a backwards step. Tendon pain is not the same as pulling or injuring a muscle, muscles repair much quicker, tendons adapt and change at a much slower rate. There is no set time frame from which we can map out your recovery perfectly because many different factors can influence it. It would be wise however to prepare yourself for a period of 3-4 months rehabilitation to get the results you want in terms of pain and increasing your function. You also need to be prepared for a journey that may have some bumps in the road because you won’t always get it right.  Try and stay positive about your recovery, aim for a pattern of increased tolerance to activity, doing more with less pain. You can then feel happy that you are on the right path no matter how long it takes you.

 4. Graded Strengthening Exercise

Building your tendons tolerance to more activity will involve completing a graded strength programme. Strengthening exercise is the most evidence-based approach for tendon pain and should form the core of your approach to tackling this problem. Each tendon will be strengthened in a different way and this is where Physiotherapy can play a crucial role in guiding you through this process.  Gain a good understanding of what the tendon does and what exercises will strengthen it. You should take equal control of this process as you are best placed to know how your tendon responds to each exercise. You should know how to progress and regress your exercises depending on irritability and pain. Strengthening will not only help the tendon itself, but also the muscle attached to the tendon. It also helps your bodies nervous system to recruit and use the tendon again and builds your confidence in it. 

5. Prepare for those higher loads

Tendons are designed to absorb large amounts of force and stress, for example in running, the achilles tendon is absorbing forces of up to 3 times
body weight. It is therefore important that your exercises sufficiently prepare your tendon for these higher loads. If you want to return to sports or heavy manual work, then make sure your strengthening programme makes you feel equipped for the activity you are returning to. Different ways to prepare the tendon for higher levels of stress include, faster movements, heavier weights, increased volume and plyometrics. Plyometrics are exercises that involve jumping and landing, the tendon is required to stretch and then contract powerfully. These can be done in both the legs and arms, when starting these types of exercise, the volume should be kept small and built up slowly. Your Physiotherapist can help guide you through this crucial part of your rehabilitation.