Tendons are pesky little things. It feels like they sneak up on us out of nowhere and they often seem difficult to treat but there are a few things about tendons that can help direct your recovery.
1. Tendons hate change
Tendons are slow to adapt to change, so being mindful that increasing your runs or your run speed can lead to overload of the tendon structure. Slow and steady build up of loading is important.
2. Tendons don't respond to rest
Overload might be what aggravated your tendon initially, however loading is how you will rehabilitate it. The important part is how you load it and when. Offloading your tendon will reduce it's capacity, then when you return to your normal activities it is now an apparent overload.
3. Tendons like load - specific load
There are many different types of load - they vary in direction, speed, duration. The most recent research has shown that heavy, isometric load early on in the rehabilitation phase works to both improve the capacity of the tendon but also works as pain relief. Heavy isometrics are the 'tendon panadol'.
4. Tendons hate compression
Tissues can be loaded through mid-range, end-range, through-range. Tendons particularly hate to be compressed and this is often where we might see the changes and also experience pain. Compression can occur when the tendon is stretched over a bony prominence like the insertion of the Achilles tendon. Compression can also occur when a tendon is stretched - think about an elastic band, when you stretch it out the structure of the elastic becomes stretched and more narrow which is compressing this area. The same occurs with tendons.
5. Your tendon is telling you how it is going - listen to it and respect it
Understanding what your tendon is telling you will help guide your rehabilitation. The important thing to know is that tendons have a latency to their pain. So you might do exercise on a Monday but wake up sore on the Tuesday or Wednesday rather than experience pain at the time. It is important to understand the pattern of your tendon specifically to be able to monitor and progress your rehabilitation.
6. Seek assistance with your rehab and so and steady wins the race
Isometrics are the foundation for building a strong tendon, however each tendon and each person has specific requirements and goals, Understanding the needs of the tendon and person will allow a specific training program to be formulated to be able to reach those goals safely.
7. Once a tendon - always a tendon
Tendons have an amazing ability to recover in their function and ability to tolerate loading. However, should you look deeper you will find that you might still have a pathological tendon despite having no pain or concerns. Tendons have poor blood supply and a real difficulty in repairing the damaged collagen. However, tendons will thicken and make new good collagen. Once your tendon has enough new good collagen this will then act like the old damaged part and function well. Happy days. But once a tendon, always a tendon - so if you have a period where you unload the tendon and it loses capacity and then go back and overload it, then you are putting your tendon at risk of pain and poor function again.
So... listen to your tendon and seek advice. Do not push through the pain and do not offload them.
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