Let’s talk tendons! Why tendons? Because they are the source of many different pains related to running, hiking, cycling, CrossFit & hockey, to name but a few! To fix these problems & return to your chosen sport pain-free, we need to understand them. This is a very important component of treatment.
Tendons are made up of three main components:
1. Tendon cells, called tenocytes
2. Collagen fibres &
3. Proteoglycans
Tenocytes produce the collagen fibres that form the structure of the tendon. These fibres are generally aligned tightly in the direction that the muscle pulls. Proteoglycans are produced by cells (including tenocytes) and help keep the collagen fibres organised and provide lubrication so they can move smoothly against each other.
Collagen fibres in tendons are designed to handle the high forces generated by attached muscles. When you move, tendons repeatedly endure these pulling forces (known as tensile forces), but they also experience forces that compress them (called compressive forces), especially near where they attach to bones. For example, the hamstring tendon connects to a part of the pelvis near the base of your buttocks, which creates a spot where the tendon is squashed against the bone during some movements. This is normal under appropriate loading conditions, as proteoglycans attract water and help to absorb these compressive loads. There’s a fine balance however, with regards to the number of proteoglycans a tendon can have (production by the cells dictated by too much, too little or normal levels of compressive load). Too much and the tendon’s ability to endure tensile forces is reduced. Too little, and the tendon cannot absorb the compressive forces near its attachment to bone. This can occur with runner’s who over-stride with a slower than optimal cadence or one who runs with tight hip flexors and a forward tilting pelvis. The tendon adapts by attracting more proteoglycans to absorb the high compressive forces, but in turn sacrifices its tensile strength to cope with the demands of running. This can result in a proximal hamstring tendinopathy which can be very painful.
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Tendons thrive on the right amount of load. With appropriate loading, the balance of cellular activity within the tendon supports maintenance or strengthening of the tendon structure. However, too much or too little load disrupts this balance, causing the tendon structure to break down, leading to pain and / or dysfunction.
For example, running can disrupt tendon balance in various ways, such as:
1. Rapidly increasing your weekly mileage, speed, frequency, or elevation gain
2. Returning to running too quickly after a break
3. Running with mechanics that aren’t ideal for the distances you’re covering
4. Running with weak or with less-than-ideal muscle recruitment patterns
5. Inadequate recovery times between training sessions
If you’re running or playing sport with pain, chances are that you’ve got a problem with your tendon. There’s no recipe for treatment but they can be fixed. A comprehensive assessment & treatment plan addressing load, form, recruitment patterns and strength will help you gain control of your symptoms and ultimately enjoy pain-free running again! The longer you put up with the pain, the longer the road is to recovery.
This is APA Sports Physiotherapist, Darren Glendenning, signing off for now!
You can book an appointment with Darren or Newcastle Knights Physiotherapists Katie or Hayd'n at www.upnadamptphysio.com
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