I realise this is a running blog, but runners are often afflicted with tendon injuries, most notably in the achilles or patellar tendons. Below is a basic article that was published in Ski Trax magazine. In fact, you will find my regular column in Ski Trax throughout the winter season. Enjoy!

Tendon Injuries

Like many things in medicine, tendon injuries cover a broad spectrum of severity ranging from mild strain type injuries to complete tendon failure and ruptures. In the past, treatment of such injuries has consisted of rest, ice and anti-inflammatory (NSAID) medications, but in the last few years there have been new developments in the treatment of these common injuries.

In basic terms, tendons are thick, fibrous sinewy structures that connect muscles to bones. Tendons are comprised primarily of dense collagen fibres. When a muscle contracts the tendon acts to move the bone at the other end, across one or more joints. We refer to tendon pathology as a tendinopathy or tendinosis. The term tendinitis is being used less, as we now know that there is actually little in the way of inflammation in most tendon problems.

When a tendon is stressed beyond it's tensile limit, micro-tearing may occur within the structure of the tendon. There is swelling, acute pain, and the tendon may feel creaky to touch. In the first few days there is certainly inflammation, and icing and anti-inflammatory medications can provide relief, but but we now know that this inflammation is likely a beneficial process, leadingl to recovery, and over zealous use of NSAID medications can actually be detrimental to healing. I recommend NSAIDs for a few days only, with rest and regular icing. After this initial period, however, a program of gradual tendon loading seems to produce the best results. A physical therapist will typically prescribe a program of gradual eccentric loading, to 'stress' the tendon in a controlled fashion to stimulate blood flow, new collagen production, and healing. Of course, more severe injuries such as complete ruptures, require prolonged immobilization, and even surgery.

Recent research has focused on the management of more chronic tendon pain. It seems that often the healing gets 'stalled', once the initial inflammation subsides. Irritating these tendons, increasing the blood flow in the damaged area, and trying to increase the inflammation can kickstart healing. Nitroglycerin patches, typically used to treat heart problems, applied to the skin overlying the injury causes blood vessel dilation, increased blood flow and stimulates new collagen production. Vigorous massage across an injury (cross-frictions) has similar effects. Physical therapists may dry-needle injuries or use a form of deep acupuncture (IMS), in an attempt to inflame the tendon and start the healing process. More recently, injections of either dextrose (prolotherapy), or a patient's own growth factors in the form of platelet rich plasma (PRP) has shown promise. 

As always, it is best to consult a professional with experience in treating the specific injury.

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