Don’t Rest Tendons
If you’ve been running long enough, odds are you’ve experienced some sort of tendon pain. Unfortunately, tendons can be the biggest pain-in-the-ass (sometimes literally) of all running injuries to deal with. In this blog we’ll look at everything tendon pain and how to deal with it based on your personal factors and timeline of pain. Below are the most common tendons injured in runners.
Patellar Tendon
Proximal Hamstring Tendon (the pain-in-the-ass I was talking about)
Glute Medius Tendon
Risk Factors
First, there is pretty much one main cause of tendon pain and that is “too much too soon, after too little for too long”. However, there are several factors and combinations playing into that cause, which makes things a little more complicated than just one thing. The most common ingredient, when it comes to running, to a “too much” injury is always training. Whether that is duration, intensity or running terrain, like hills and uneven trails, our bodies need time to adapt to training and will likely let you know if you’re doing too much. Secondly, a drastic change in shoes can play a role in “too much” injuries. For example, I switched from Nike’s at an 11 mm heel-toe drop to a Saucony at 4 mm drop and developed a mild case of achilles tendinopathy. My mistake wasn’t that I changed shoes to a different drop height, it was that I switched all my mileage from 11mm to 4mm which put “too much” compression force on my achilles. In hindsight, had I switched off initially between the two shoes and gradually weaned out my Nikes to my new shoes, I would have likely avoided the discomfort and let my achilles adapt to the increase in forces. While those are the major contibuters to “too much too soon” things like poor recovery (i.e. decreased sleep, not enough or poor nutrition) and comorbidities like, diabetes and obesity but “too much” force and strain on tendons. Finally, I wouldn’t be able to consciously publish this if I didn’t take a moment to talk about how medications can impact tendons. The most dangerous of them all comes from the Flouroliniquone family including Cipro, Flaxin and Levaquin. I have heard several horror stories of people tearing major tendons walking around their house after starting rounds of these antibiotics. Additionally, prolonged Statin use can have a similar effect on some.
Symptoms
One of the major goals of mine with this blog besides giving you the knowledge to hopefully avoid and manage tendon pain on your own is to make sure you can tell if you’re dealing with something more sinister than tendon issues. Because tendons get irritated with compression against bone, often tendon pain occurs right next to if not directly on a bone. Therefore we want to make sure that we are not dealing with any sort of stress fracture or bone stress injury. With that said, the golden rule with tendonopathies is that they should always warm up. This means that once you get going in the mornings or started on your run your pain should go away. Now this pain may come back later after resting for long periods of time. This is totally normal and it will be used to help identify if we are doing the right things when managing tendon pain. If your pain is exacerbated during running and gets worse with activity we are likely dealing with something a lot more serious and at this point you have to get in to see somebody. Also, we should be able to squeeze the pain. This means that there should be a very focal and isolated point of the tendon that we can squeeze to located the irritation, not the entire tendon. With the latter we have to match the pieces with golden rule of warming up as bone stress injuries will be very focal as well.
“I know I’m dealing with a tendon, now what?”
To come up with a plan of attack to help remedy tendon pain we need to have an idea of where you stand with personal factors and timeline of pain. If this is just something that has just started and you have no history of tendinopathies, then we want to take away the irritating stimulus (see risk factors). It’s very important to follow this as catching these early can save you a lot of headaches and generally resolve in a few weeks. If we have just jumped in training volume or intensity significantly then we want to get rid of it and take a break from anything that’s faster or going to irritate that spot. If we’ve just changed shoes then we should probably look to incorporate our older shoes into our training and allow our body to adapt to the new shoes. If this happened out of the blue, with no changes to anything we can still take an approach of reducing our stress on the tendon by reducing our running and monitor how our symptoms respond. If this has been going on for a long time and you’ve been ignoring it like most of us runners tend to do then we are probably in a later stage. Also, as we age, we tend to get fall right into a later stage of tendinopathy. Unfortunately when we get into these later stages we can be looking at upwards of 6-12 months of dealing with these. If there’s any good news with this we aren’t doing any further damage and are fine to run as long as we listen to our symptoms and don’t let them get out of control. With a later stage we want to continue to challenge our tendon as well as increase their strength and thickness through loading them. Either way we do not want to rest a tendon. While we may take a rest from running, we still need to continue to load the tendon as that is what they respond best to.
Each of these will require different positions to properly load and challenge the tendon. There are always infinite exercises that can be performed for any part of the body. To see a few of my go-to’s jump down this rabbit hole to my Youtube channel to watch exercises and further explanations. When beginning to load irritated tendons we need to use our response and symptoms to decide if we are doing too much or too little. If the next day we have a significant increase in soreness then we know we’ve done too much. If we are not seeing any decrease in symptoms right away we may not be doing enough or not dealing with a tendinopathy at all. We want to target isometric exercises (long holds) for pain management and target slow heavy resistance training with minimal to no pain or for prevention.
“I’m onboard with the exercises. How many should I do?”
When it comes to prescribing exercises again everyone will differ and should be based on symptoms. General starting points for isometrics start with 5-8 holds of 10-30 seconds, while slow and heavy resistance training will be 3-4 sets of 5-8 reps at 8/10 intensity or “really hard” resistance. Each of these should follow 2 minutes rest between reps for isometrics and sets for slow resistance.
Summary
If there’s anything you take away from this blog, I hope it’s two things: tendons should warm-up and do not rest tendons.
If the pain/irritation does not warm-up then we are likely not dealing with a tendon, which could have much more serious implications.
If the pain/irritation fits in this box of tendionpathy then we absolutely should not be resting it. Even at the lowest possible meaning of the word we have to continue to load the tendon.
This content is intended for patient education, not clinicians. If you would like references regarding the information provided, please email strideptco@gmail.com.