Tendons, the connective tissues that join muscles to bone are known for being notoriously difficult to treat once injured. The reason for this is that often they are injured through stress or overuse, and compared to muscles they can have relatively poor blood flow, which is essential for healing.
Tendons and muscles work together to move your joints and together are called a contractile unit. As muscles are exercised and gain strength, the attaching tendons are also placed under tension and adapt to this to become stronger. If the load placed on the tissues exceeds their capacity, the tendon fibres can begin to break down and become stiff and painful.
Is my pain related to a tendon injury?
For an accurate diagnosis, you will need to be assessed by a physiotherapist. However, some signs that your pain might be coming from an in issue with a tendon are;
· The pain is quite specific and can be felt over the tendon itself;
· The pain is worse when under stress and improves when rested;
· The pain improves after exercise has started, but it might be worse once you cool down;
· The area around the tendon may feel stiff after periods of rest, particularly in the morning.
How are tendon injuries treated?
When it comes to recovery, tendons are often treated differently to other injuries. While each tendon injury is unique and will require assessment and intervention by a physiotherapist, there are a few general approaches that usually help with all tendon injuries.
Reducing your activity to a comfortable level is the first step to recovery. Complete rest can actually delay healing as the tendon simply becomes weaker and less able to cope with subsequent loads. Your physiotherapist can provide you with a targeted exercise program to aid your recovery. Eccentric exercises, which are exercises that work alongside gravity, have been shown to stimulate tendon healing and strength.
Stretching may aggravate your injury and should be used with caution. Assessment of any biomechanical faults or stresses that are placing undue load on the tendon is also a central component of treatment. Your physiotherapist is able to guide you with your recovery and return to sport to avoid aggravating any injury.
Nothing can ruin your enthusiasm for a new workout program faster than the pain and stiffness that sneaks up on you the day after. This delayed reaction from your muscles, known as DOMS (delayed onset muscle soreness), has affected almost all of us at one time or another. While there is no sure-fire cure or prevention for DOMS, here are a few tips to help reduce your symptoms next time you hit the gym
Understand what it is
DOMS is thought to be a result of micro tears in muscle tissue during eccentric exercises in particular. While DOMS is not a sign of a serious injury and usually goes away on its own within 48 hours, it can be very uncomfortable and a deterrent to continue exercising. It can also leave you at a higher risk of injury, and for athletes who are competing in a tournament and need to recover quickly, DOMS can be particularly problematic.
Warm-up and cool-down
By taking the time to let your muscles warm-up, your muscles can operate at optimum flexibility, reducing the tension on muscle tissue during exercise. A cool-down encourages effective blood flow to muscles after exercise, so that any waste products such as lactic acid and calcium can flow back into the bloodstream rather than staying in the muscle tissues.
Get a massage or use a foam roller
By massaging tight and sensitive muscles, you can improve blood flow, promote tissue healing and reduce pain. Both massage and foam rolling can help to relax tight muscles and enhance tissue recovery in the first 24-48 hours after exercise.
Keeping hydrated allows your body to remove waste, stay flexible, and help tissues heal optimally. The trick is to maintain hydration throughout your day, not just when it's time to exercise. It's also essential not to wait until you are thirsty, as you could already be dehydrated at this point.
Other ideas includes gentle exercise such as 20 minutes on a stationary bike, and mild stretching. If you are particularly brave, ice baths have recently been shown to have mild benefits in pain reduction following intense exercise.
Running is a great way to stay in shape, manage stress, and increase your overall wellbeing. However, it's not without its drawbacks. While being a low-risk activity, there are a few injuries that commonly affect runners. As running is a repetitive impact activity, most running injuries develop slowly and can be challenging to get on top of. Here are three of the most common conditions faced by runners, all of which can be helped by your physiotherapist.
1. Runner's Knee:
Runner's knee (patellofemoral pain syndrome) is a persistent pain at the front or inside of the knee caused by the dysfunctional movement of the kneecap during movement. The kneecap sits in a small groove at the centre of the knee and glides smoothly up and down as the knee bends and straightens. If something causes the kneecap to move abnormally, such as muscle imbalance or poor footwear, the surface underneath can become damaged, irritated, and painful. The pain might be mild to start with, but left untreated, runner's knee can make running too painful to continue.
2. Shin Splints:
Shin splints (also known as medial tibial stress syndrome) is a common condition characterised by a recurring pain on the inside of the shin. While the cause of this condition is not always clear, it is usually due to repeated stress where the calf muscles attach to the tibia (shin bone). Why this becomes painful is likely due to a combination of factors that can be identified by your physiotherapist to help you get back on track as soon as possible.
3. Achilles Tendonitis/Tendinopathy:
The Achilles tendon is the thick tendon at the back of the ankle that attaches the calf muscles to the heel bone. The amount of force that this tendon can absorb is impressive. It is vital in providing the forward propulsive force needed for running. If the stresses placed on the tendon exceed its strength, the tissues begin to breakdown and become painful. Treatment is focused on helping the healthy tendon tissues to strengthen and adapt to new forces while allowing the damaged tissue to heal and regenerate.
What is it?
Our knees are complex hinge joints, designed to provide stability from side to side and smooth movement forwards and back as you walk, kick and run. The patella, or kneecap, is a small bone embedded in the tendon of the quadriceps muscle that protects the knee and also provides extra leverage to the quadriceps, amplifying their strength. The patella moves up and down in a groove at the front of the knee as the knee bends and straightens. Usually this movement is smooth, with little friction, however, if something causes the patella to move in a dysfunctional way, the soft tissue between the kneecap and the knee can become irritated, causing pain in a typical pattern. This condition is often referred to as ‘runner’s knee’, PFJ syndrome or patellofemoral pain syndrome (PFPS).
What causes it?
The patella usually sits in a balanced position in the shallow groove at the front of the knee and moves easily without friction. The patella is attached to the quadriceps muscle at the top and connected to the lower leg via the patella tendon at the bottom. When the quadriceps contracts, this pulls on the patella and acts to straighten the knee. If one side of the quadriceps is stronger or tighter than the other, it can cause the kneecap to pull to one side and over time become irritated.
There can be many factors that cause a muscle imbalance or weakness on one side of the quadriceps. In most people, the outer aspect of the quadriceps tends to be stronger and tighter than the inner muscle.
Certain postures and leg positions require the outer muscles to work harder and the inside muscles to become less active. Lack of arch support in your feet or simply a physical abnormality of the knee can also place stress on the movement of the patella.
What are the symptoms?
This condition is characterized by pain felt on the inside or behind the patella with activities that require repetitive bending of the knee. There may be a sensation of crunching, clicking or grinding and some people report that their knee suddenly gives way. The pain is commonly felt when running, going up and down stairs or when doing squats and is generally relieved with rest. The pain may start as a small niggle and gradually become worse over time.
How can physiotherapy help?
The first step in effective treatment is to exclude any other conditions and have a physiotherapist confirm the diagnosis. Your physiotherapist is able to determine which factors are contributing to this condition, which could include poor posture, a lack of arch support in your feet or poor running technique.
Once these factors have been identified, you will be provided with a specific treatment program to best approach your condition. PFJ syndrome usually responds well to biomechanical analysis and correction of any muscular weakness and imbalance. Having the correct shoes and orthotics can also make a huge difference. There are some short-term treatments, such as patella taping, dry needling, trigger point therapy and ultrasound, which may help alleviate symptoms quickly and keep you active while you address the other factors contributing to your pain.