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Tendon Injuries By Dr. Lyle J. Micheli

Tendons are the tough, ropelike tissues that connect muscle to bone. They are strong but not very flexible.

In sports where repetitive movement is required, such as running, tendons become injured from frequent, low-intensity overloading.

Tendon overuse injuries are known as tendinitis. This condition refers to microtears of a tendon caused by repetitive, low-intensity overstretching. For instance, Achilles tendinitis is common in runners because of the repetitive stretching of the heel cord. Other tendon injuries seen in runners are iliotibial band syndrome (knee) and patellar tendinitis (knee).

Like many overuse injuries, tendinitis is often ignored because the symptoms develop slowly. Few sports injuries, however, are as difficult to treat as tendinitis. Because of poor blood supply, healing is very slow. For this reason, it is crucial that runners who develop tendinitis treat the condition early to avoid extended layoffs from sports and long-term dysfunction.

Preventing tendinitis

Prevent tendinitis from developing in the first place by following these guidelines:

Have a presports physical to (1) rule out natural tendon tightness that causes microtears in the tendon fibers due to normal stretching during physical activity and (2) rule out imbalances in strength or flexibility between any tendons and their adjoining muscles, or between tendons on one side of a muscle-tendon unit and tendons on the opposing side.
Engage in a conditioning program to develop strength and flexibility in the muscle-tendon units so they are not as vulnerable to microtears in the tendon fibers due to normal stretching during physical activity.
Perform a proper warm-up and cool-down before physical activity to prepare the tendon fibers for the normal stretching of exercise.
Wear appropriate footwear to reduce or eliminate overstretching of the Achilles tendon during exercise.
Observe a progressive training regimen to minimize rapid increases in exercise frequency, duration, or intensity that can overstress the tendon.

Prevent mild tendinitis from becoming a chronic condition by following these guidelines:

Cease running.
Use the RICE prescription.
Take acetaminophen or ibuprofen as label-directed.
Do not return to running until there is absolutely no localized tenderness or pain when using the muscle-tendon unit.
Gradually return to running when the symptoms are gone.
Seek medical attention if the condition persists for more than two weeks, despite conservative self-treatment.

Prevent a chronic tendinitis condition from becoming permanently dysfunctional by following these guidelines:

Withdraw immediately from running.
Use the RICE prescription.
Take acetaminophen or ibuprofen as label-directed.
Seek expert medical attention as soon as possible.
Carefully follow the rehabilitation program and do not return to running until cleared by the doctor and the physical therapist.
Gradually return to running.

Excerpted from Healthy Runner's Handbook, 1996, by Dr. Lyle J. Micheli.

Additional excerpts from Healthy Runner's Handbook--#1 and #2.