THE SOWERBY PHYSIO FILES - WHAT ABOUT TENDONS?

​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

CLICK HERE TO LEARN MORE ABOUT COACH HEIDI!