A Closer Look at Tendon Disorders, Exercise and Treatment

Tendons are located at the ends of our muscles. They are the tissue that anchors the muscle onto a bone. Fortunately, tendons are very strong and able to withstand large forces. This is why they are very resilient in the grand scheme of our anatomy. They are subjected to tremendous forces to transfer forces from our contractile muscles to our bones. Unfortunately, the trade off seems to be tissue recovery. When they are damaged, tendons seem to take a long time to recover, especially when we compare them to the healing rate of muscle tissue.

Tendon Disorders

There are many different tendon disorders as we’ve discussed in many previous blogs. Tendon rupture and tendinitis are examples. Perhaps the most common tendon disorder that we see at our clinic is tendinopathy or tendinosis. The hallmark of these tendon disorders is the absence of inflammation (which is usually seen in tendinitis or rupture) and “disorganized” tissue related to tendon degeneration. To give a visual, think of a rope that is frayed. Common tendons that become injured this way include Achilles tendons, rotator cuff tendons (supraspinatus, infraspinatus, subscapularis and teres minor) and elbow tendons related to golfers and tennis elbow.

Treatment Options

There are many treatment options for tendon disorders – Active release, Graston, acupuncture, laser therapy, massage therapy; the list is rather large. One exercise approach that has become very popular in recent years is eccentric exercise for tendon disorders. Eccentric exercises (known by many exercise enthusiasts as “negatives”) involve lengthening of a muscle/tendon while under load. A simple way to think of this is the lowering phase of a bicep curl.

An interesting paper published in the American Journal of Sports Medicine investigated whether laser therapy combined with eccentric exercise improved the recovery time for Achilles tendinopathy. It did. So here are the pertinent facts about the study that practitioners and patients might find important…

• Laser therapy treatments occurred twice a week for four weeks. Then the treatment weaned down to once a week for four more weeks. The total was twelve laser therapy treatments.
• Patients were also instructed to stretch the calf muscles on a regular basis.
• The eccentric exercises were performed four times a week over eight weeks. The exercises started with body weight and then added four kilograms in a backpack as necessary. Single leg calf raises were performed with the focus on lowering (eccentric). The knee was straight. Initially, patients were instructed to perform one set of fifteen reps. From there, the program built to being twelve sets of twelve repetitions with one-minute rest. As expected with eccentric exercise, mild pain was acceptable but should not be unbearable nor last more than a day.

The point of this blog is not to solely apply this research to the Achilles tendon but perhaps consider this as a reasonable effort to treat various tendon disorders. The combination of laser therapy and a regular eccentric exercise protocol has some evidence to support it and, like many treatment strategies, will work very well for some patients but perhaps not as well for others. This study has shown us that laser therapy combined with eccentric exercises is a reasonable strategy for tendon disorders, especially the Achilles tendon.

Reference

Stergioulas A et al. Effects of low-level laser therapy and eccentric exercise in the treatment of recreational athletes with chronic achilles tendinopathy. American Journal of Sports Medicine 2008; 36(5): 881-887.