By Professor Jill Cook.

  1. Rest completely

    The old adage of use it or lose it applies to tendons, resting just decreases the ability of the tendon to take load. It also affects the muscle attached to the tendon and the rest of the leg, leaving the person with less ability to load the tendon. Conversely you cannot ignore the pain (point 4), you have to reduce loads to the level that the tendon can tolerate and then slowly increase the tolerance of the tendon to load.

  2. Have passive treatments

    Treatments that do not address the need to increase the ability of the tendon to take load are not usually helpful in the long term, although they might give short term pain relief. Treatments like electrotherapy and ice will only temporarily ameliorate pain only for it to return when the tendon is loaded.

  3. Have injection therapies

    Injections of substances into a tendon have not been shown to be effective in good clinical trials. In fact many of them are based on the false premise that tendons heal like other tissues and that there is a capacity to return a pathological tendon to normal. Do not have injection in a tendon unless the tendon has not responded to a good exercise based program.

  4. Ignore your pain

    Manage the load on your tendon, pain is a way of telling you that the load is too much. Reduce the aspects of training that are overloading your tendon (point 10).

  5. Stretch your tendon

    Aside from the load on your tendon when you play sport, there are compressive loads on your tendon when it is at  its longest length, adding stretching to most tendons only serves to add compressive loads that we know are detrimental to the tendon. Stretching while you are standing can be especially provocative to your tendon. If your muscles are tight use massage to loosen them.

  6. Massage your tendon

    A tendon that is painful is one that is telling you that it is overloaded and irritated, therefore adding further insult by massaging it can actually increase your pain. Sometimes tendons will feel better immediately after a massage but can then be worse when you load them.  As mentioned in point 5, massage of the attached muscle can be helpful.

  7. Be worried about the images of your tendon

    The pictures of your tendon with ultrasound and MRI can frighten you, and the words used by doctors such as degeneration and tears can make you wonder if your tendon should be loaded. There is good evidence that the pathological tendon can tolerate loads, especially when you gradually increase the loads on them.

  8. Be worried about rupture

    Pain is protective of your tendon, it makes you unload it, in fact most people who rupture a tendon have never had pain before, despite the tendon having substantial pathology in it (see point 7).

  9. Take short cuts with rehabilitation

    Taking short cuts with rehabilitation do not work, you need to take the time that the tendon needs to build its strength and capacity. Although this can be a substantial period (up to 3 months or occasionally even more), the long term outcomes are good if you do the correct rehabilitation. Things that are promised as cures (see point 3) often give short term improvement but the pain recurs when the loads are resumed on the tendon.

  10. Not have an understanding of what loads are high for your tendon

    The highest load on your tendon is when you use it like a spring, such as jumping, changing direction and sprinting. Any loads that do not use these movements are low load for a tendon, so exercise using weights and exercise that is slow will not place a high load on the tendon, although they can certainly have a beneficial effect on the muscles.

Summary

The take home message is that exercise-based rehabilitation is the best treatment for tendon pain. A progressive program that starts with a strength program and then progresses through to more spring like exercises and including endurance aspects will give the right loads on the tendon and the best long term results. Make sure you see a qualified health professional with expertise in this area to guide your rehabilitation.

Lower Limb Tendinopathy Symposium

LASEM’s staff Jill Cook, Ebonie Rio and Sean Docking join Craig Purdam in delivering a fantastic weekend lower limb tendon symposium in early September. This symposium is brought to you…

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