Tendon pain in the lower limbs is the curse of many runners and other athletes. Part of the difficulty with tendons is that they are structured quite differently to the rest of the musculoskeletal system (as they receive little blood flow) and hence they don’t respond to the standard treatments. Thankfully some very smart physiotherapists (no, I am not referring to myself here!) have worked out how to tame the beast to help you return to your chosen sport/activity.
The following list of tips for lower limb tendon pain are from Jill Cook, a renowned world expert physiotherapist here in Australia. Under each tip I have provided my own explanation to help make it easier for the layperson to understand.
1. Do not completely rest the tendon
I am a big believer in the saying “use it or lose it” and tendons are a perfect example of why this is the case. It has actually been shown that complete rest can reverse any healing that may be occurring within the tendon. Instead of complete rest, try to reduce your running load to a level your tendon can handle. A good way to know that your tendon is handling your current running load is if you give yourself a pain score out of 10 each morning when you first step out of bed (where 0 = no pain and 10 = the worst pain you can imagine). If the score is no worse on mornings after you have run then you have found a level of loading that your tendon is more comfortable with. Once you have calmed the tendon down to a consistent level (or no pain) then you can start to gradually build up your running again.
2. Don’t ignore your pain
This point links in perfectly with the first tip to not completely rest the tendon. You have pain in your tendon for a reason. That is, your tendon is not coping with your current running load and it will not recover if you continue with your current exercise regime. You will need to reduce any activities that cause your tendon pain. This is an example of why “no pain, no gain” is not one of my favourite sayings!
3. Understand what your tendon perceives as good or bad exercise
OK, so you have tendon pain…but that does not mean you must be confined to a swimming pool for the rest of your days. There are many activities that can be done without increasing your tendon pain, and some of these may even reduce your pain. Working the muscle attached to your painful tendon either isometrically (working the muscle while it is not moving i.e. like pushing a bus) or very slowly has been shown to act like a painkiller for your tendon. Do it well and you will get instant pain relief, albeit temporary but at least you can still hit up the gym and stay active.
Exercises that make the tendon work the hardest (and therefore have the most potential for causing damage) are activities that use the tendon as a spring. Jumping, sudden changes of direction and running are all good examples of exercises that work the tendon at a high level. This does however open the door for many cardio-based exercises because they don’t include spring like movements. Cycling, swimming, boxing while sitting down and the cross trainer.
4. Don’t take short cuts
There is no easy answer or short cut for overcoming a problematic tendon. The rehabilitation is a long slow process because you need the tendon to build strength and capacity. And that does not happen overnight.
Unfortunately, once you have tendon pain you will always be vulnerable to it coming back. You will always have to stay consistent with your running load. If for some reason you are not able to run for an extended period of time, when you do return to running you will have to be very careful to progress slowly due to your increased vulnerability.
5. Don’t massage a tendon
A tendon is a very different structure from a muscle. It is composed of strong and non-pliable collagen and has very little blood flow relative to a muscle. Whereas a muscle can respond with a decrease in tone or an increase in blood flow that results from the massage process, a tendon is more likely to get irritated with such contact. Therefore, just stick to massaging the attached muscle rather than the tendon itself.
Stay tuned for ‘Tips for Tendon Pain – Part 2’ (which will include another five tips) which I hope to get done as soon as my young son allows us to have a full night’s sleep!
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Darren McMillan is an experienced AFL Sports Physiotherapist for the Richmond Football Club and also provides consultations in Brighton East (Melbourne) at aPhysio including both evening/weekends sessions. Visit www.aphysio.com.au for more information and online bookings.