Do you have an annoying, frustrating tendon injury/tendinopathy? What role does exercise have in pai

You know that irritating, annoying, frustrating achilles pain or that patellar tendon (front of the knee aka jumper’s knee) pain? These aggravating tendon injuries are often referred to as tendinopathies.

Tendinopathy is a broad term used to describe injury in or around a tendon often in response to overuse. These can cause a significant amount of pain and dysfunction.

Recent research actually suggests there is little or no inflammation present in these conditions, which is why terminology has changed from “tendinitis,” which implied there was inflammation occurring.

Many people and athletes continue through the pain for a period of time because with tendon injuries, pain often decreases as the tendon gets warmed up. Then, it will get worse after activity or worse the day after activity.

With patellar tendinopathy (jumper’s knee), it is very common in sports requiring a lot of explosive movements such as basketball and volleyball.

So, what can we do about this and how can we treat it?!

Studies suggest that exercise may be the best treatment for tendinopathies! (YAY for physical therapy!) They have shown positive changes within the tendon (i.e. histopathological changes) AND clinical improvements in pain and function. Many studies show benefit and positive results with eccentric exercise protocols, however these may not be of benefit with an athlete that is in season or someone who is in training! Eccentric exercise involves lengthening the muscle while the muscle is contracting. Eccentric exercise often leads to increased delayed onset muscle soreness compare to other types of exercise.

That is where ISOMETRICS and ISOTONICS come into play!

• Isometric:

• Type of muscle contraction where the joint angle or muscle position does not change during the contraction

• 4-5 reps, 40-60 sec holds, 2x/day

• Isotonic:

• Generate force by changing the length of the muscle

• Heavy, slow resistance training

• 3-5x/week

These types of exercise have been shown to reduce tendon pain while ALSO allowing the individual to continue sporting activity! Thus, these may be better options rather than eccentric training in-season or during training for athletes!

Isometric exercises have shown an immediate pain-relief effect in multiple studies. One study found that isometrics for patellar tendinopathy were able to decrease pain in the short-term (45 minutes), however did not look at long-term effects. Some studies suggest isometric exercises have a greater effect at reducing acute pain, whereas isotonic exercise may have more of a gradual effect at reducing pain.

An in-season randomized controlled trial on athletes with patellar tendinopathy found that isometric contractions had more of an immediate pain-relief effect than isotonic exercise. Thus, this greater analgesic effect of isometric contractions may allow increased ability to load the tendon and increased ability to perform, which at the end of the day is what the athletes want to be able to do: PERFORM! The parameters used in the isometric protocol in this particular study were the following:

• Knee extension isometrics @ a 60 degree angle of knee flexion

• 5 x 45 second holds @ 80% of your maximal force

• 1 minute rest between sets

• Progress force by 2.5% each week if able to tolerate

^^ Knee Extension Isometric--the left knee here would be pushing against the black pad, however the angle of the knee joint would not change (i.e. the weight on the machine would need to be heavy enough that you would not be able move it when you begin to contract the quad muscle)

• What type of exercise should I do?

• How many should I do/how much load/force?

• How often should I do the exercises?

• What if I have pain when I do the exercises?

These are all great questions and can vary person by person! That is why it is so important to see a physical therapist, where a full movement assessment can be done to determine the proper starting point and plan for YOU!

To schedule an appointment with me:

Call: 614-437-9002 OR Email: khartley@grandviewprimarycare.com

*Pricing is available on our website!

Kaitlin Hartley, PT, DPT

#physicaltherapy #tendinopathy