Tendonitis or tendinopathy as we have learned to call it today can be a nagging and persistent type of pain that you may feel that nothing you do will help. This does not have to be the case when taking an anatomical and functional approach to tendinopathy.

When in pain and having tendinopathy, complete rest is not advised. It is imperative to continue to remain active, reintroducing stress to your tendon and muscle in a pain-free manner. Removing the painful stimulus is the first step, whether that is reducing running mileage to a distance that does not bother you, holding off of a particular activity or type of movement. It is rare that we tell someone to simply not to do a particular activity but rather educate each person on strategies to put themselves in the best possible position for success.

It is important to manage compressive and tensile loads on a structure with tendinopathy. A muscle and tendon is put under load when it is contracting or stretching. For example, when you squat your hamstring is being stretched over your ischial tuberosity on the descent, putting stress on your high hamstring tendon, as well as your glute tendon is put under high tensile load on the way back up when it is contracting to return to standing.

We now have to ask ourselves what we can do to perform an activity or get back to an activity feeling better, moving better and performing better.

Progression of Tendon Loading

Reintroduction of load and stress on a tendon and muscle must be done in a systematic and thought out process.

Your body does not know sport-specific when you are in pain. It realizes there is a problem, a threat, to how it normally operates and your brain sends a painful signal to you in order to alert you that something is not right.  

Tom Goom, a researcher out of the United Kingdom, talks about five steps in which you should introduce load back onto yourself, starting from muscle contractions with no change in tissue length, isometric, to full range and quick change in tissue length and load in a plyometric with compression.

  1. Isometric (Early stage and less provocative)
    • Holding a PAIN FREE muscle contraction with no change in tissue length
  2. Isotonic
    • Tension remains unchanged but the muscle length changes
  3. Compressive Loading
    • Muscle contraction with increasing stress and/or moving through greater ranges of motion
  4. Plyometric Loading
    • A muscle exerts high force over a short period of time
  5. Plyometric Loading with Compression (Late stage and most provocative)
    • A high force, short period of time, through a greater range of motion

Sites of Compression

Sites of tendon compression is a key consideration with progression of tendon loading. When we discuss the progression of loading, there are particular areas in which a tendon or soft tissue may have a higher compressive force on a boney prominence–think Achilles tendon on your calcaneus (heel bone). This is why we systematically introduce stress with gradually increasing joint range of motion, tissue tension and compression.

Here is a chart showing tendons with their common site of compensation:

tendinopathy_site_of_comperssion

borrowed from Tom Goom’s running-physio.com post from 2013

I have seen far too many times when individuals have insertional achillescalf stretch, running, soccer
tendinopathy, one of the first interventions a practitioner may jump to is the calf stretch at the wall. This is a beneficial stretch and has a purpose in recovery however if you have achilles pain, putting the joint into end range ankle dorsiflexion (see photo) is adding unnecessary compression to the tissue. This stretch is one example of a good treatment utilized frequently at the wrong time.

Sites of tissue compression and proper load progression are crucial pieces to recovering from tendinopathy. If you currently have a tendinopathy or have in the past and have questions about progression back to being pain free, performing the activities you love, feel free to post a question or email me at mike@peakperformancect.com.