Tendon Injury

Are you trying to look for the best way to treat your tendon injury? In this article, we provide you with all the information you need to first understand what a tendon injury is, and then what is required to provide pain relief and to help it to heal without surgery.

What is a tendon injury?

A tendon injury is classed as damage or inflammation located within the soft-tissue structure that helps to connect muscle to bone. Tendons are similar to ligaments in the sense that they are both connective tissue and made up of collagen, but ligaments have no relationship with muscle and just connect bone to bone. The collagen fibers in tendons are tightly packed and run parallel with each other. This tightly packed formation helps them to withstand force and keep a joint stable during movement. Tendons have a poor blood supply which is why they can be so vulnerable to injury and also the reason why they struggle to heal very quickly. The majority of injuries occur close to joints. There are three main types of tendon injury:

• Tendinitis – inflammation or irritation of a tendon, typically from overuse. This is most common in the following areas of the body:

1. Flexor tendons in the elbow, clinically known as tennis elbow or lateral epicondylitis.
2. Extensor tendons in the elbow, clinically known as golfer’s elbow or medial epicondylitis.
3. Supraspinatus tendonitis – problems with this tendon can also affect bursa in the same area.
4. Patellar tendonitis – this can also affect the infra-patellar bursa.
5. Quadriceps tendonitis
6. Gluteal tendinopathy
7. Hamstring tendonitis

• Tendinosis – is where the collagen of a tendon degenerates as a response to chronic overuse.
• Rupture or tear – this is when fibers of the tendon have completely torn or partially torn. The most common tendon to suffer from a complete rupture is the Achilles tendon. Tendon tears can often accompany ligament injuries and sprains. For example, an inversion sprain of the ankle ligaments can also cause damage to the tendons.

Tendinitis and tendinosis may also be referred to as tendinopathies.

Symptoms of a tendon injury

You may experience one or more of the following signs and symptoms:

• Pain – this often gets worse with activity. Some tendon injuries can cause sharp pain during certain movements. For example, a tendinopathy of a rotator cuff tendon.
• Stiffness – normally experienced several hours after activity or the day after activity.
• Night pain and stiffness – resulting from a build-up of inflammation when the tendon isn’t moving.
• Tenderness
• Swelling
• The tendon may feel warm
• Clicking and crunching – if the tendons are tight then they can make a sound as they flick over bony prominences.
• An audible snapping sound at the time of the injury – this is normally only for full tears of the achilles tendon.

Causes of a tendon injury

The majority of tendon injuries are associated with repetitive activities such as typing, running and tennis. Our muscles were designed to absorb most of the force during a movement, but if they are tight or weak then a lot of that force ends up transferring into our tendons, causing inflammation. The poor blood supply of a tendon means that they recover very slowly. If the repetitive activity is repeated on a continual basis without giving enough time for the tendon to recover then it leaves some of the fibers in the tendon vulnerable to tearing. For example, if a tennis player is playing tennis a few times a week without stretching or massaging his forearm muscles.

Risk factors

• Tight muscles – performing activities without stretching before and after.
• Age – muscle fibers become more rigid as you age so more force ends up transferring into tendons. Also, blood supply to tendons starts to decline so the recovery rate slows down even further.
• Misalignments – if your joints are misaligned it causes your tendons to work at angles that they weren’t designed to.

How is a tendon injury diagnosed?

The majority of tendons are diagnosed with an ultrasound scan. If more specific detail is required then an MRI scan can be performed.  X-rays cannot show tendon injuries.

Treatment

Prolotherapy

Due to their poor blood supply, tendons don’t recover and repair as quickly as other structures that have a good blood supply do. The main reparative compounds of blood are oxygen and nutrients. Prolotherapy is a treatment that involves the injection of a regenerative solution into an injured tendon. This helps to stimulate the production of fibroblasts. Fibroblasts help to secrete the collagen needed to repair and strengthen injured tendon tissue. The injected substance is very thin so it has the ability to spread into the injured area much more effectively than other types of injections.

The following video testimonial is of a patient of ours called Dean. He came to the clinic suffering from shoulder and elbow tendonitis.

Other Treatments

Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help in the acute phase to reduce the inflammation. They can have side-effects if taken for too long.

Rest and cold packs: this is only advised in the acute stage of the injury if there is still inflammation and bruising present.

Use of a splint: a splint can help to immobilize the joint associated with the injured tendon whilst it is trying to heal. A splint is typically used for tendinopathies of the wrist.

Physical therapy: a physical therapy program will help to strengthen the muscles associated with the tendon injury. This will help to take the pressure off the tendon and allow it to heal.

Platelet-rich plasma (PRP): this is a type of injection that involves removing a sample of blood and separating the red and white blood cells from the plasma. The plasma is rich in growth factors that can help to repair damaged body tissue.

Shockwave therapy: this is a type of therapy that is performing a machine that delivers shockwave into the affected area of the tendon. It helps to stimulate the healing process in injuries that are struggling to heal on their own. Shockwave therapy can treat a variety of different soft-tissue injuries and can also treat issues associated with the heel bone.

Surgical treatment: A surgical tendon repair is usually only recommended for complete tears or severe partial tears.

Corticosteroid injections: this involves the injection of anti-inflammatory medication to reduce the inflammation in the tendon. Unfortunately, many studies have shown that they can weaken the fibers of the tendon.

How to prevent a tendon injury

There are several things an individual can do to help to prevent a tendon injury:

• It is important to warm up muscles and perform regular stretching before and after physical activity.
• Monthly sports massage into the muscles that are related to the tendons under the most strain. For example, if you are a tennis player then it would be your forearm muscles. If you are a runner then it would be your leg muscles. Massage into the quadriceps muscles can help to prevent the reoccurrence of patellar tendon problems.
• Perform regular strengthening exercises for muscles associated with previous tendon injuries. For example, if you have had an achilles tendon rupture in the past then it is particularly important to strengthen the calf muscles. Or if you have suffered tennis elbow then it is important to strengthen the forearm muscles. If you have had a history of sports injuries then a practitioner at a sports medicine clinic can help to prescribe the most appropriate strengthening exercises to help prevent a reoccurrence of those injuries.

Frequently asked questions

How long does it take for a tendon to heal?

Tendons have similar healing times as muscles. If an individual needs orthopaedic surgery then the healing time can range from between four months to a whole year.

Do tendon tears heal on their own?

Only a partial tendon tear has the ability to heal on its own but it depends on the severity of the injury. It is not advised to leave a tendon to heal on its own as there is a risk of scar tissue building up in the affected area.

How can I make tendons heal faster?

Prolozone therapy is one of the most effective ways to help a tendon heal faster.

What happens if a torn tendon is not repaired?

If a tendon is not repaired then the joint that the tendon attaches into can become weak and unstable. This weakness and instability can start to cause ligaments of that joint to overwork. For example, if a quadriceps tendon tear hasn’t healed properly then it can cause the knee to become unstable and ligaments such as the anterior cruciate ligament to overwork.

Can a torn tendon heal without surgery?

If the tendon still has a large number of fibres intact then there is no reason why a torn tendon can’t heal without surgery.

Do tendons get stronger with exercise?

Tendons are able to get stronger through exercises. The best type of exercises to improve strength in tendons is resistance exercise as it helps to promote blood flow to the fibres.

What causes weak tendons and ligaments?

Previous injuries can cause weak tendons and ligaments. Certain hypermobility syndromes such as Ehlers-Danlos syndrome (EDS) can cause ligament weakness and laxity.

What supplements strengthen tendons and ligaments?

Collagen-based supplements help to strengthen tendons and ligaments.