Tendinopathy affects approximately 30% of runners and involves a combination of pain, swelling and decreased performance (Li & Hua 2016). Most commonly affected are the Achilles tendon and the Patellar tendon, likely due to the repetitive strain and the amount of force absorbed through those
tissues while running. (Ackermann & Renström 2012).
Tendinopathies typically begin as a dull stiffness in the knee, calf or ankle that gradually relieve as the area warms up during activity. Left unchecked, the tendon can remain painful for the duration of your run as well as between training. This can be a big source of anxiety for runners and result in inadequate preparation or even missing events (Taunton et al. 2002). Causes of tendinopathy can vary and depend on many factors such as flexibility, strength, muscle imbalances, joint mobility, running style, sex, age and body composition. (Zafar et al. 2009)
Managing tendon pain
Tendon pain doesn’t have to be something that you just have to put up with as part of your training. But you need to get on top of it! Exercise, specifically isometric exercise to the affected tendon, seems to be a key factor in reducing pain and improving function (Kongsgaard et al. 2006) An isometric exercise is when there is muscle contraction but no joint movement. Think of a plank exercise for the core, the abdominals are contracted and active but there is no movement happening. This is an isometric contraction.
Research shows that isometric loading of tendons reduces pain and improves function in athletes during their competitive season more effectively than any other mode of exercise. Isometric loading can be a helpful tool when experiencing tendon pain while training for competition as its quite simple to perform and doesn’t compress the already irritable tendon. Once the initial pain and irritation has subsided, heavy and slow exercises to the tendon can be done to build strength in the tendon and muscle. This can be followed by plyometric (jumping and hoping) exercises to fully and effectively rehabilitate the effected tendon. (Lim & Wong 2018)
If you're struggling with Achilles or Patellar tendinopathy, here's a few examples of isometric exercises to help with your pain in the early stages:
1. Isometric Achilles tendon holds
This exercise can be performed at end-range or mid-range (all the way up on toes or
half way up). If the tendon is highly irritable you can use you non-symptomatic leg to help, otherwise it should be performed using just the single affected leg.
- Stand on a step and raise up onto your toes slightly
- Hold this position for 45 seconds
- Take a 15-30 second rest then repeat the hold another 4 times making sure to rest for 15-30 seconds between each set
- This can be repeated 3-4 times per day
2. Isometric spanish squats for Patellar tendinopathy
This exercise involves placing a non-elastic strap behind the knees and tying the strap to an immovable object. You then lean back against the strap and squat down to a knee flexion of 70-
- The knees should not translate towards the toes and the shin bone should
remain directly above the ankle.
- The torso should be upright and not lean forward.
- The squat should be held at a level that is not extremely painful in the front of the knee. The discomfort that is experienced should be due to the muscle fatigue in the thighs and buttocks.
- The goal is to perform 45 second holds 5 times.
- This can be repeated 3-4 times per day
Pain doesn’t necessarily always mean damage to tissues. There are many factors in our life that can make us more or less susceptible to feel pain. Sleep, stress, relationships, work demands, nutrition, and many other influences are all factors that can contribute to lowering or raising your threshold or ability to feel pain. Professor Lormeir Moseley, a pain scientist, suggests that the attention, expectations and anxiety you have regarding pain gives pain it’s meaning and therefore contributes to the intensity of an individual experience’s. (Moseley & Butler 2015). For example, a runner, two weeks out from a marathon, who gets a small niggle in their knee post run may place a lot of attention on that niggle as well as have some anxiety regarding what that niggle means to the future of their running. As a runner, it’s not too difficult to imagine this scenario and understand how it can draw attention, anxiety and alter our expectations around running which will ultimately result in higher perceived pain levels.
The great news is that understanding our nervous systems are capable of amplifying pain in this way seems to increase our pain threshold.
Osteopaths are able to assess what is causing and contributing to an individual’s tendon pain by assessing posture, movement, health history and using specific orthopaedic tests. They can give you a good understanding if your training program, stress levels, sleep, shoes, or strained tissues are contributing to your symptoms. Then develop a tailored treatment and rehabilitation strategy involving manual therapy, exercise and lifestyle advice to help you recover and get back to doing what you love!
If you're struggling with tendinopathy or another pain and have an event coming up, you can book in to see Jared at Balanced Osteopathy - available Tuesdays and Thursdays for Osteopathy.
Click here to book or call our reception team on 0203 0962900.
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