Now that the weather is FINALLY cooperating and the sun is shining, it’s time to hike! You’re still in shape from ski season, so a long and strenuous hike sounds perfect. You wake up the next day with a stiff Achilles, but it goes away rather quickly. By the time you’re done with morning coffee, you’re ready to hit the trails again. Maybe you think, “Hey! Everything feels good! Let’s try a little jogging!” By the next morning when you step out of bed, that Achilles stiffness is more intense, and gets worse as you hike. You turn around, discouraged after 15 minutes. The tendon must be inflamed, you think. What happened? “Everything was feeling so good! Maybe I’ll just ice and rest for a few days and it’ll feel better.” Only, it doesn’t get better. You try some exercises you find on line that are guaranteed to help. Now it’s even worse.
4 MYTHS ABOUT TENDONITIS
1.Your tendon is inflamed
First off, that’s not the right word. When you have a painful tendon, people often say you have tendinitis. You see, “itis” means inflamed – think, red, swollen, hot. When a tendon has been painful for a while, that’s rarely what’s going on. A tendon can become irritated when you increase mileage too fast, or switch to a new activity that stresses different muscles. And when a tendon becomes reactive, your body starts laying down cells in a helter-skelter fashion. You end up with a thicker, painful tendon, but it’s rarely inflamed. While the thickness helps support the rest of the tendon, it doesn’t really do you any good otherwise. And, you can’t strengthen that damaged tissue. So what you really have is tendinopathy, which means tendon disease. But all hope is not lost!
2. Just rest and it’ll get better
While we are not saying you should work through pain, resting causes tendons to weaken. That’s why switching from skiing all season (where the tendon is in a bootand not working very hard) to a really long uphill spring run is a bad idea. Tendons stay healthiest with the same load, delivered the same way. Every. Single. Day.
So if you change your routine, do it gradually. Tendons are slow to change. Muscles and even bones have excellent blood supplies and adapt quickly to altering routines. The blood supply to tendons is not as robust, so tendons take time to get stronger, but they can and will respond with proper guidance. ALTA PTs will know exactly what you need: focusing on strength and activity tolerance first, then adding speed or propulsive movement.
3. Tendons Heal
As we mentioned above, tendinopathy will have a lot of disordered tissue. On an MRI or ultrasound, this disordered tissue looks like there’s a hole. In fact, this “hole” is filled with cells, fluid, and disorganized protein chains. Though the “hole” will not change with rehab, the surrounding tendon tissue is still healthy and can get stronger. The tendon may be thicker, but that allows it to compensate for the “hole” of disorganized tissue seen on imaging. Once a pocket of disorganized tissue is there, you aren’t going to change it. But you can eliminate pain and restore function.
Thickening of patellar tendons – the amount of healthy tissue (green) is the same or greater in tendon dysrepair and degenerative tendinopathy than the amount of healthy tissue in a normal tendon
4. Eccentric exercises are your ticket to treating tendinopathies
It seems counter-intuitive, but holding a near maximal isometric muscle contraction for 45 seconds (which is harder than it sounds) actually decreases pain if you have a true tendinopathy. Your therapist can guide you through specific protocols, but isometrics will have a great effect on tendon pain relief. So though we often recommend movement for healing, in this case, starting with a long hold will relieve pain and start your recovery.
But there’s more. The progression is like threading a needle with just the right amount of load, and knowing when to progress to moving, and just how fast to move. Eccentric exercise may be included, but it is not a must. You need a PT who understands you, your problem and the physiological changes that occur when a tendon starts to hurt.