​Chat to any group of runners or triathletes and you are sure to uncover some stories about how tendon injuries have interrupted training sessions, derailed race plans or made life generally miserable.  We triathletes and multisport athletes are always up for a challenge though so lets plough through this tendon game!
 
As discussed in my previous post tendons are living tissues. Tendons, are, in fact the attachments of our muscles to our bones.  As with any living tissues there is turnover of the cells that make up our tendon tissues and therefore tendons can adapt or maladapt according to the balance of training load and recovery.
 
Undoubtedly, the most common tendon injuries encountered in the triathlon world are lower limb injuries related to impact loads such as running – full body weight with a large impact factor, repeated hundreds or thousands of times on a run. 
 
The tendons such as the achilles, the high hamstring up in the gluteal region, the patellar tendon at the knee and the peroneals in the outside of the lower leg are the most common sites for tendon related pain. 
 
The jury is still out as to what causes tendon pain, but the most accepted theory right now is that the pain comes from biochemicals that sensitise nerve endings in the tissues in and around the tendons.
 
But…GREAT news here!  The link between actual pathology on imaging and pain is a less likely explanation to pain – even if there is “pathology” on imaging, it doesn’t have to explain your pain or even dictate your outcome.
 
What to do if you have tendon pain?  Well, whilst tendons can be a pain in the butt, or ankle or knee for that matter…  you can -

1. Find a great physio or sports physio who does a thorough assessment, prescribes exercises and educates you about tendon related issues.  Remember tendons need loading exercises (and not just passive treatment) to adapt and function better!! 2. Do your exercises – tendons are living tissues that respond to appropriate load.  Your exercise program should include progression of load and intensity from simple static exercise all the way through to return to sport.  Exercises should be done consistently, often on a daily basis. 
   
2. Talk to your physio about your multisport training program and how it integrates into your tendon management.
   
3. Remember the brain can also be involved in interpretation of pain – consider the impact of your psychology on the pain experience.
   
4. At the end of the day, remember YOU are the only person who can get your tendon pain better!  Understand the issue, educate yourself, do the exercises and be a part of making great decisions about the balance between load and recovery! 

 
Ah yes, and then lets go back to our exciting triathlon/ multisport world.  The juicy stuff – what can I do with my actual swim/ bike/run to potentially help in this tendon game you ask?
 
Some great ideas to think about are:

1. Involve your coach in your tendon rehab process – great info leads to smarter decisions made together – GO TEAM!  
2. Consider your running load – if you have a new onset of tendon pain, modify the load, but DON’T STOP running (ah, my vision is of triathletes jumping for joy) if you can help it.  A smarter move is to reduce the run load to a tolerable level that doesn’t cause the tendon to flare up.
   
3. Consider your biomechanics – chat to your physio or coach about your run gait and have it assessed.  
4. Consider your run cadence – the high hammy tendons, in particular, do not like load under compression so shorten your gait and up your cadence.
   
5. Consider your bike fit – again high hammy tendon pain may not appreciate aggressive time trial positions.  Patellar tendons may not appreciate low seat heights. EEK!  
6. Adjust your swim/ bike/ run balance – if you need to reduce your run load for a bit, why not tackle your swim or bike fitness?!  UBER SWIMMER COMING UP!

 
As with any progression toward a great race day performance, tackling tendon issues can require a lot of patience and persistence.  Luckily these are qualities that are innate to our triathlete and multisport population!!!
 
So, in the spirit of the determined athlete - climb that mountain, as, in most cases, you are in charge of your own tendon destiny  (insert grand theatrical music)!!
 
Next up, bones and bone health – I’m excited about this one - I think we are going to have an osteoblast, and it will be kinda humerus…ha ha,.  Until next time!
 
Cheers
H

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Injury time outs ARGH!  They seem to pervade the sport of triathlon, ruining race plans, creating DNS’s and sending the consistency of training into a complete shambles!  As an athlete when the pain subsides, you are just itching to get back in the game….. 
 
Or imagine another scenario - you have just returned from a glorious offseason of beach time on a tropical island, sipping drinks from cocktail glasses with small umbrellas …. And now with renewed enthusiasm you return back to training….
 
Or perhaps you are new to the sport, or new to one of the three disciplines of swim bike or run, and ready to tackle your training plan and first race.  For example a long time competitive swimmer, moving into triathlons ….
So what do all these scenarios have in common? Apart from likely being periods of high enthusiasm for training, they also represent prime periods for injury risk of the musculoskeletal kind…. the kind of injuries that, as a physio in my former life, had athletes knocking on the door and kept me suitably employed!
 
So, whilst this blog may not be your first choice read if you are in offseason lounging beside the pool, it is my intention that there are some useful gems that you will glean from your time investment here and it will help you avoid ending up in injury rehab or DNS land.
 
So please read on - this is TISSUE ADAPTATION 101. Whilst most of us have a decent understanding of improving cardiovascular fitness, often less thought is given to how your tissues, i.e muscles, ligaments, tendons and bones adapt throughout your training and racing cycles. 
 
It is quite often the case that your cardio fitness (also known as a central adaptation) improves well ahead of your biomechanical (or peripheral) adaptations and your tissues just can’t keep up.  Hello niggles or worse, hello injury.
 
What muscles, ligaments, tendons and bone have in common are they are LIVING tissues with a cellular makeup that changes and adapts to stress.  The concept of stress and adaptation of tissues is not unlike the concept applied to cardiovascular fitness.  For your living tissues to adapt, they must have an appropriate stimulus and then appropriate time to adapt. 
 
Tissues can adapt in both a negative or positive direction. Too little stress and tissues can weaken, resulting in a lower tolerance to stress.  For example after a period of detraining or injury, because of the reduced load, there is often a reduced tolerance to physical stress of the tissues.
 
At the other end of the spectrum, even with some fairly hefty training and resilience in the bank, there is often a breaking point.  An upper limit so to speak for athletes  - based on their genetic make up or biomechanics/ the way they move. Although this is a topic for another day, never fear, what you think is your upper limit may not necessarily be so and there may be steps you can take to extend this!

So, armed with some introductory knowledge on tissue adaptation, where to from here?  For now, the message is that positive adaptations in your tissues are forged through appropriate amounts of training stimulus with appropriate periods of recovery.
 
Be patient with the plan set by your coach,  and train with a measured sense of progression - your living tissues of muscles, bones, tendons and ligaments will thank you.
 
The reward for your consistency and patience is more glorious runs with friends, ocean swims with mates and bike rides along country roads.  Awesome!
 
Next up, I will delve into the first of our living tissues, our tendons.  Well, not because they are first on any priority scale but I know of a few high hammy and Achilles tendons having a party out there…  and if you know a few runners or triathletes you probably do too!!

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