Tendinopathy, a 'hell' of injury

tendinopathy y poolwater 135What can an injury and a career have to do with it? Well, in my opinion, what both are hell.

In the month of July, the poolwater 135, also known as the race from hell for being one of the toughest ultra-endurance tests in the world (perhaps the toughest) due to the terrible heat conditions (bordering on and even exceeding 50 degrees Celsius) that prevail during the 217-kilometre route.

In the world of injuries, as with ultra-distance running, there are also some that can be considered hell. One of them, I can affirm after many years of experience as a physiotherapist, is tendinopathy, both Achilles and patellar.

Achilles tendinopathy and patellar tendinopathy, injuries highly feared by runners

Tendinopathy is, briefly stated, a tendon inflammation. It is an injury greatly feared by athletes, especially by athletes.redpray and heartredyou pray. And the reason she is so feared is that to overcome it you have to go through hell; a hell that ends up taking its toll both physically and mentally.

Both Achilles tendinopathy (also called Achilles tendinopathy), which affects the gastrocnemius and soleus tendon, such as the patellar tendinopathy, which affects the quadriceps tendon in the insertion of the tibia, are lesions that they condemn the athlete to dry dock.

In this article we are going to analyze the reasons why it is such a difficult and complicated injury to solve.

Whenever there is a tendon injury, it is a consequence and rarely the cause, therefore it is necessary to find out what biomechanical or training situation has generated this ailment.

Tendinopathy is not an injury that can be determined with date and time when it occurred. It is an injury that It can manifest from one day to the next.; one day you're fine and the next you hurt like hell at the muscle attachment.

Signs that can alert us to a tendinopathy

There are a number of signs that can alert us to tendinopathy. On many occasions it happens that the athlete ignores these signs that clearly may be indicating that the structure is suffering. And those signs are:

1. General tiredness. Rest is the basis of training.
2. Pain in joints used in the racing discipline in which one competes.
3. Muscular weakness in lower limbs.
4. Sensation of muscle pain in the morning that improves after a while with movement.
5. Proprioceptive failure (joint instability) of joints.
6. Pain before exercise that goes away when you train and then comes back.

Frequently asked questions about tendinopathy

When talking about tendons, many questions always arise. One of them is: Why is the tendon such a special structure for a person who runs?; another is: Why does the tendon take so long to recover?

We are going to answer the first of the questions: Why is the tendon such a special structure for the running? The tendon structure is super special for two reasons:

1. It is the structure that will administer the mechanical force of the muscle to the bone to be able to exert movement, being a non-elastic structure.
2. It is a structure with a slow metabolism and little vascularity, therefore, once the immune system is injured, it does not have a large contribution and usually heals worse.

Regarding the question of why a tendon takes so long to recover, we should start by clarifying that the tendon is a structure with a slow metabolism that is responsible for administering loads and that it needs movement to heal; resting and not moving is the worst choice because the tendon needs mechanical stimuli to accelerate its self-care and recover effectively.

In case of resting, the muscle weakens, forcing the tendon to suffer more than necessary and damaging it every time an effort is made for which it is not prepared because it is forced to be the main actor in the movement.

A tendon takes time to heal because the destruction of collagen after exertion is greater than the synthesis of collagen, which occurs about 24/48 hours after exercise. What does this mean? Well, if we do high-intensity exercise every day, we will always be in the process of collagen destruction and we will never reach the collagen synthesis necessary to heal and recover that tendon.

Therefore, after a high intensity exercise we must perform low intensity exercises for the next 72 hours so that the tendon does not suffer. If we add the poor vascularization of the structure, with this type of training we will generate the perfect situation for the recovery of this tendon, since after this time the synthesis is greater than the destruction of collagen, allowing us to increase the intensity of the training for 3 days after the last high training load.

If we are able to respect these 72 hours between high-intensity workouts, we will get the necessary time for the tendon to recover correctly.

But what happens if we do not respect this time? That the tendon is injured and when the tendon is injured it can do so in 2 ways: becoming inflamed or destructuring.

Types of tendinopathies: tendinitis and tendinosis

The first thing we have to tell apart es if the tendon is inflamed or unstructured. If the tendon is inflamed, it is called tendinitis; and if the tendon is unstructured, it is called tendinosis. The latter, tendinosis, is a more serious tendinopathy than tendonitis because the destruction of the tendon can generate complete rupture.

Physiotherapy treatment does not address tendinosis in the same way as tendinitis. In the case of tendinosis, since the complete structure is not there to generate force, it cannot administer loads; In the case of tendinitis, inflammation is often good for activating the immune system, for healing, so it must be respected.

Depending on the type of tendinopathy and always evaluated by medical diagnosis with ultrasound and diagnosed by a physiotherapist specializing in sports and sports rehabilitation, we must differentiate which types of exercises are good in each case.

If the injury is inflammation, the physiotherapist must respect it and create a battery of exercises that, after biomechanical assessment through applications such as VALOBANDO, generates a specific exercise plan for each athlete; These exercises will always have to be in the line of doing eccentric work that improves the situation of the tendon fibers.

If the injury is a disorder, the physiotherapist must control the loads and do specific treatment to improve the tendon tissue.

Cold is contraindicated in tendinosis processes since it prevents the immune system from having the ability to heal due to its vasoconstriction. However, in tendonitis processes, it is good to apply ice at the end of the day to get rid of pain after training, since ice has analgesic effects.

Heat therapies are indicated for two reasons:

1. They improve the immune system and blood supply to the area.
2. They heat the tendon to improve the kinematic part of the tendon.

Tips to avoid suffering a tendinopathy

The best way to control tendinopathy is not to cause it, so what should a corredpray not to suffer it?

1. Perform specific exercises for each athlete in an objective and effective way evaluated with the VALOBANDO application (we will talk about it in the next post).
2. Go to the doctor for ultrasound evaluation and to the physiotherapist for ultrasound control of the tendons involved in gait.
3. Go to the physiotherapist for treatment using manual therapy and physiotherapy techniques to remove tone from the overloaded muscles.
4. Have a good training program with sports professionals and a good recovery program with physiotherapists specializing in sports injuries.
5. have a good alimeRich in protein and vitamins.
6. Do not ignore the signs mentioned above that could be indicating that the structure was suffering.

The best way to prevent tendinopathy is not to suffer it, but if a tendon injury is suffered, it is extremely important that the athlete knows that he is facing a slow recovery injury and he has to know that this is going to test his mental strength because it is necessary to accept with resignation the necessary time for the total and optimal recovery.

The mental part of a tendon injury is essential for the athlete to be able to return to sports in a healthy way. Tendinopathy has a healing period of more or less 1 year of evolution, and continued treatment is extremely important even if there is no pain, since many times a tendon injury does not imply pain.

The case of Iván Penalba

En BOX55 we have been taking care of Iván Penalba since 6 years ago. Given the extreme competitions that it faces, such as the Badwater 135, we have always feared that he could suffer tendinopathy because for an athlete like him it could be a hell of a lot more than a race like the Badwater 135 (Iván Penalba finished second in his first participation in the Badwater 135 in 2022 setups).

The loads that an athlete supports can come from many parameters: distances, force, impact, speed, terrain and even metabolic situations. That is why it is very difficult to modify and control loads on an athlete like Iván Penalba, who, when he does 217 kilometers at 50º through the Valley of Death, will generate an average of 400.000 impacts.

Bringing the body and in this specific case the tendons to such an extreme load situation requires a lot of training, mental strength and, above all, prevention.

Iván Penalba could not do what he does without a group of physiotherapists who take care of him every day and plan recovery and care sessions for his tendons throughout his season.

You can read other articles related to injuries that concern runners in our blog. If you are interested, you can learn more about low back pain in the article entitled “Lumbalgia, the good weather injury”. If your interest is related to hamstring injury, you can find more information in the article “Hasquitibial rupture, injury to fear”. Other items of interest may also be “Tips to prevent meniscus injury” o “3 golden rules to prevent sprained ankles on the trail” running".

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David Valenzuela Diaz

Physiotherapist at BOX55

David Valenzuela Díaz has a degree in physiotherapy from the Cardenal Herrera CEU University and a Master's degree in assessment, physiotherapy and sports rehabilitation from the University of Valencia. He is CEO of BOX55 Fisioterapia y Academia SL, of BOX55 Academy and of Valobando SL Functional Biomechanical Analysis.
David Valenzuela, CEO of BOX55

Other entries by David Valenzuela Díaz

• Pubalgia: what it is, where it hurts and how to cure it
• The 'knee of the corredor', a hip problem
• Injuries to the running, Prevention is better than cure