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Tendon Pain - Ten Things To Avoid!

MELBOURNE. Excessive and incorrect loading as well as signs of wear and tear are a common cause of painful changes in the tendons of the lower extremities, especially in athletes who run a lot. But there is still no agreement on the optimal treatment for these complaints.

In any case, active therapy with targeted exercises should be carried out and rehabilitation should be carried out consistently. According to Jill Cook from La Trobe University in Melbourne, it is also important to inform patients about the following ten points that have definitely not proven helpful (Br J Sports Med 2018; online February 23).

These are the 10 don'ts

  1. Complete rest Anyone who goes into complete rest due to their pain not only risks stiffening of the tendon within two weeks and a loss of function of the kinetic chain. Muscle strength also decreases quickly and the ability to exercise dwindles. The painful strain on the tendon should first be reduced. They are replaced by isometric exercises. Once the pain has subsided, the load can be increased slowly in order to restore the functionality of the tendon.
  2. Wrong exercises Even early in the rehabilitation phase, the tendon can be lightly stressed through slow exercises. Jumps, sprints or quick changes of direction should be avoided. It is also important to ensure that the tendon attachment is not compressed.
  3. Passive action The recommendation of passive measures leads to the fact that the patient himself does nothing to improve his symptoms. This also does not increase the load-bearing capacity of the tendon. Measures such as electrotherapy or ice temporarily improve the pain. However, with renewed stress it occurs again.
  4. Injection therapies In clinical studies, no difference was found between the effects of substances and placebo after injection into the painful tendon. The pain may subside for a short time, but this should only be considered if a good exercise program has failed.
  5. Ignorance of the pain The pain level usually increases 24 hours after the tendon is overloaded. If the pain increases by 2 or more points on a scale of up to 10 in the daily exercise test, the training that caused it should be reduced. An overload of the tendon occurs especially when jumping, running and changing direction.
  6. Stretching of the tendon Stretching puts pressure on the junction between tendon and bone, which has an adverse effect on the tendon.
  7. Friction massages If the tendon is overloaded and irritated, the pain from the friction during a friction massage can increase further. A pain-reducing effect on local nerves is only short-term, with higher stress the symptoms return.
  8. Imaging procedures Ultrasound or MRI are not suitable tools for diagnosing tendinopathies. The vascular supply or possible tears also give no indication of the course. In the course of treatment, even if the pain subsides, there is usually no change in the pathology that was initially shown in the imaging.
  9. Fear of rupture The pain automatically protects the patient from straining the tendon. In fact, most people do not feel any pain when a tendon breaks and therefore do not see a doctor.
  10. Incitement in rehab Tendons need time to regain their stability and functionality. While this can take three months or more, with proper and complete rehab the long-term results are good.

Those ten approaches, Cook said, were going in the wrong direction and hampering a progressive program of painful tendon management. Such a start with measures to strengthen the muscles and then move on to springy exercises. By constantly adapting endurance, the tendon is adequately stressed over time, which leads to the best long-term results.