Managing Tendinopathy in Runners – Exercise and Pain Education

What is a tendinopathy? How to manage tendon pain? In this blog we answer these questions and more to keep you running and performing for your next marathon. 

Tendinopathy affects approximately 30% of runners and results in pain, swelling and decreased performance. Most commonly affected are the Achilles tendon and the Patellar tendon, likely due to the repetitive strain and the amount of force absorbed through those tissues while running.

What is a tendinopathy? 

A tendinopathy is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement.

Lower limb tendinopathies typically begin as a dull stiffness in the knee, calf or ankle that gradually relieve as the area warms up during activity. Left undiagnosed or treated, the tendon can remain painful for the duration of your run as well as between training and at rest. This can be a big source of anxiety for runners and result in inadequate preparation, further injury or even missing events. Causes of tendinopathy can vary and depend on many factors such as flexibility, strength, muscle imbalances, joint mobility, running style, sex, age and body composition. However in most runners it is a combination of a few of the above. 

How to Manage Tendon Pain?

Most people’s first instinct is to completely stop exercising and fully rest, however research suggests that loading the tendon is the most effective way of managing tendon pain.  Exercise, specifically isometric exercise to the affected tendon, seems to be a key factor in reducing pain and improving function. An isometric exercise is when there is muscle contraction but the joint itself does not move. Think of doing a plank – the abdominals are contracted and active but there is no movement happening. This is an isometric contraction. 

Research shows that isometric loading of tendons reduces pain and improves function in athletes during their competitive season more effectively than any other mode of exercise. Isometric loading can be a helpful tool when experiencing tendon pain while training for competition as its quite simple to perform and doesn’t require you to rest (something no one wants to do!). Once the initial pain and irritation has subsided, heavy and slow exercises to the tendon can be done to build strength in the tendon as well as the muscle. This can be followed by plyometric (jumping and hoping) exercises, or those that are sports specific, to fully and effectively rehabilitate the affected tendon. 

If you’re struggling with Achilles or Patellar tendinopathy, here’s a few examples of isometric exercises to help with your pain in the early stages:

1. Isometric Achilles tendon holds 

This exercise can be performed at end-range or mid-range (all the way up on toes or

half way up). If the tendon is highly irritable you can use you non-symptomatic leg to help, otherwise it should be performed using just the single affected leg.

  • Stand on a step and raise up onto your toes slightly
  • Hold this position for 45 seconds
  • Take a 15-30 second rest then repeat the hold another 4 times making sure to rest for 15-30 seconds between each set
  • This can be repeated 3-4 times per day
Isometric Achilles exercises for tendon pain in runners

2. Isometric spanish squats for Patellar tendinopathy 

This exercise involves placing a non-elastic strap behind the knees and tying the strap to an immovable object. You then lean back against the strap and squat down to a knee flexion of 70-90 degrees. 

  • The knees should not translate towards the toes and the shins should
  • remain directly above the ankle.
  • The torso should be upright and not lean forward. 
  • The squat should be held at a level that is not extremely painful in the front of the knee.  The discomfort that is experienced should be due to the muscle fatigue in the thighs and buttocks. 
  • The goal is to perform 45 second holds 5 times.
  • This can be repeated 3-4 times per day

Other than isometric exercises- tendons respond well to normal injury protocols, such as:

  • Anti inflammatory medication (ask your pharmacist for recommendations)  
  • Reduce impact and reduce load (decrease number or training sessions or distance) 
  • Ice and heat where appropriate 

Pain Education in Tendon Pain

Pain doesn’t necessarily always mean damage to tissues. There are many factors in our life that can make us more or less susceptible to feeling pain. Sleep, stress, relationships, work demands, nutrition, and many others all influence to the lowering or raising your threshold to pain. Professor Lormeir Moseley, a pain scientist, suggests that the attention, expectations and anxiety you have regarding pain gives pain it’s meaning and therefore contributes to the intensity of an individual experience. For example, a runner, two weeks away from a marathon, who gets a small niggle in their knee post run may experience heightened levels of pain and anxiety, compared to a Sunday jogger.  

The great news is that we are now better able to understand our nervous system, and how perceptions of pain does not necessarily correlate to tissue damage. 

If you suspect you have a tendon injury, ensure you seek the correct management. Your osteopath, physiotherapist and/ or chiropractor will be able to give you a correct and more accurate diagnosis, treat the tendon and surrounding area with a mixture of hands on soft tissue technique and manipulation. Dry needling treatment can also be very effective with both acute and chronic tendon issues. You will also be prescribed an appropriate rehab program, to ensure quick and efficient recovery.

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