Tendinopathy - causes and treatment
Why do we develop tendon pain/tendinopathy from running?
Tendons are strong, resilient structures. They are designed to carry heavy loads, for example, the Achilles tendon can receive a load of 3.9 times body weight during walking and 7.7 times body weight during running! Despite this, they can become a source of pain and can be quite stubborn to settle.
Tendon pain often starts when there is an imbalance between what our tendon is able to do (the capacity of the tendon to withstand loading forces) and what we are asking it to do (how much load we are placing on the tendon).
The imbalance can be caused by factors that might affect the health of the tendon, reducing it’s capacity to take load, like an illness, hormonal changes or a lack of sleep can be enough. Alternatively, we might simply be putting too much stress on the tendon, for example tendon pain might start after a sudden increase in running speed or an increase in the amount of hill running. If this exceeds what the tendon can tolerate, pain and sometimes swelling can be the result.
How can tendon pain be settled?
If we reduce the load on the tendon when we first develop symptoms, it is likely that the symptoms would settle. For instance, temporarily reducing running distance or having a rest from hill running might be enough to calm the tendon down. However, this relies on a runner being aware of when there is a problem and not putting it down to just ‘normal’ aches and pains from running. It is also quite difficult for a runner to reduce training down, especially if they are otherwise progressing well.
If the tendon is continued to be loaded excessively, changes start to occur in the tendon which in turn will increase symptoms of pain and swelling. This is the point that people tend to seek help as running is invariably affected.
At this point, we first need to manage and settle the painful symptoms. This is done through careful modification of the loads placed through the tendon. This might mean reducing running volume or intensity or avoiding aspects of a run, such as hill running. In some, severe, cases a recommendation to stop running for a period of time might be advised, however in a lot of cases running can be continued... phew!
How can we get back to running at normal pace and distance?
Once the pain has settled, the focus needs to be shifted and moved towards building the strength and resilience of the tendon back up. Through placing load onto the tendon, in a controlled way, the tendon becomes better able to tolerate stresses and strains and therefore better able to tolerate running! The good news is that tendons have an amazing ability to adapt their structure in response to exercise.
Rehabilitation should include some functional exercises that are designed for running, some quite heavy resistance work and eventually exercises that focus on power. These should be considered alongside building up distance and then speed.
Other factors for a successful return to running might also include:
- The identification and treatment of biomechanical factors that might affect how we run, for example, foot position when the foot makes contact with the ground, how the pelvis moves when we go from one leg to the other;
- The factors that might affect the health of the tendon, such as hormonal or metabolic influences on the tendon. These might make recovery slower and will therefore need to be considered in treatment planning; or
- Psycho-social factors that might be a barrier to successful treatment. It is important to treat the person and not just the injury. We all have psychological and social factors that will contribute to the pain we feel and to our recovery to varying degrees.