The types of tendon injuries are largely due to the variety of shapes and structure of the tendon. The bicep tendon being long and thin as is the Achilles tendon. The tendons of the latissimus muscles are more of a sheet-like facial structure covering a large attachment. Because a tendon attaches a muscle to a bone the primary function of tendons is to transmit force or energy from muscle to bone which creates movement when muscles are engaged. The way the fibers run along the length of the tendon gives it its tensile strength. This tensile strength gives it about twice the strength of its associated muscle and as a result are less likely to be injured compared to the muscle. Even when there is a complete rupture of the muscle it is usually at the musculotendinous junction, which is where the muscle attaches to the tendon, and thus the weakest point of the contraction chain where two different fibers meet.
In some cases it’s the muscle fibers which remain intact and the tendon tears or pulls away from its attachment at the bone. This is known as an avulsion. The most common tendon pathology has been often referred to as tendonitis but now is more correctly known as tendonosis which is an abnormal condition of the tendon. Tendonitis was referring to an inflammation of the tendon from overuse and lead to fiber tearing but is now known that true tendon fiber tearing with inflammation does occur but is rare.
In the case of tennis elbow, for instance, there is usually slight tearing and inflammation of either the extensor carpi radialis longus or brevis. This is the tendon attachment at the bony elbow protrusion on the outside of the arm called the lateral epicondyle. A test for this syndrome is to resist the extension of your wrist, which is bending the wrist back with resistance. The pain may increase with continued use over a few weeks. During this time the tendon may suffer hundreds of micro tears and the development of scar tissue. Simple chores like opening a door, carrying a bag or shaking hands can induce a sudden intense pain.
Without treatment tennis elbow can last a long time. If there is tearing the injury should be allowed to heal before treatment. Treatment protocols can be simply icing the site, rest and local friction by a trained professional to either prevent scarring or to decrease it.
Most tendon overuse dysfunctions show no inflammatory cells but involve the breakdown of the collagen matrix. This makes the treatment at the site more accessible and long lasting. Another result of tendonosis is the amount of blood flow. Treatment to encourage blood flow to the site greatly enhances the recovery process. Many of the treatments still encourage anti-inflammatory rehabilitation strategies rather than collagen rebuilding. Unfortunately many of the anti-inflammatory regimens such as corticosteroid injections and oral anti-inflammatory medications can be detrimental to collagen regeneration. If tearing were the issue the tissue would repair quicker as it moves through the inflammation and repair stage process on its own along with manual neuromuscular re-education.
The more common tendonosis sites I see are at the hamstring attachments, Achilles/calve injuries, tennis elbow and rotator cuff. Usually you hear someone say, “Oh, I pulled a hamstring!” It feels like it’s in the middle of the muscle but usually it is at the attachment on the “sit bone” that is the culprit. This is common when a large muscle attaches at a small site. Achilles tendonosis can sometimes refer pain to the bottom of the foot lending to a false diagnosis of plantar fascitis. Treatment to the attachment at the heel and the entire calf usually has good results.
The main thing is not to “work through it” Missing out on a few days of tennis or golf is not the end of the world. Enjoy the sunshine and stay off the board and off the volleyball court for a week. It’s OK! Ice it down, rest it, get treatment and you’ll be back in no time. Severe tears should be medically appraised for possible surgical reattachments, but if it’s just a strain it can usually heal itself.
Robert Bonavolta is a licensed massage therapist specializing in Neuromuscular Therapy focusing on chronic pain management and sports injuries. He is also an AFAA certified personal trainer and a certified Spinning® instructor. For more information appointments and Spinning class schedule call the Montauk Wellness Center and Atlantic Corrective Therapy and Massage at 631-668-0300 or visit the office at 6 South Elmwood Avenue along with Local Beauty with Maureen Jacob, LE, offering corrective skin care, facials, peels, waxing, spray tanning and massage as well as local arts and crafts and skin care products. And now also in East Hampton 9 N. Main St 631-764-3938. Visit us at www.montaukwellnesscenter.com
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