Athletes Treating Athletes

In the previous “How To” post we talked about the six different techniques covered so far on this site (foam roller, cross friction, trigger point, active and joint mobilizations, and stretching). We reviewed the techniques and also briefly talked about what kind of injuries each technique was best suited for. In this post, we’re going to talk specifically about tendon injuries.

Two Type of Tendon Injuries

Unlike muscle sprains/strains, tendon injuries are classified by how old they are.

Tendinitis – acute (new)  inflammation of a tendon characterized by pain (ranging from achy to burning), stiffness, and swelling along the tendon. Symptoms typically worse during activity followed by increased stiffening post activity.

Tendinosis - chronic inflammation of a tendon (30+ days) characterized by thickening/fibrosis of the tendon itself due to microtears in the tissue that surrounds the tendon. In other words, prolonged inflammation causes the tendon to physically change. The result is a loss of elasticity and an increased risk of tear/rupture.

Managing Tendon Injuries:

Step 1- Traditional R.I.C.E. treatment:

Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle/joint will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery.

Ice: while heat may feel better on stiff and sore muscles, ice only during the first 7 days following injury. This will help to decrease swelling, inflammation and pain. 10-15 minutes is sufficient and you can perform every hour as needed. Avoid direct ice to skin contact.

Compression: thanks to the recent explosion of compression sleeves, tights, shorts, etc, you have several options in this department. Ideally you want something that is snug without being uncomfortably tight (think recovery tights if you’ve ever worn them). You can also use a store brought ace wrap to accomplish this. Start the wrap below the injury using good tension on the bandage and move up above the injury. This will help keep swelling from moving down the leg.

Elevation: This is critical in the early days following acute injury where swelling may be present. In the case of an ankle injury for example, elevate the leg so that it is above chest level. This can be accomplished by laying down and propping for your foot up on the arm of the couch with pillows.

Step 2-Self Treatment Options

When a new tendon injury occurs, the first and most important goal is always to decrease pain and any swelling that may be present. In other words, we want to decrease inflammation. That means ice is mandatory. Absolutely no heat no matter how good it feels. Even if it only hurts to run or swim and feels fine the rest of the day, you still need to be icing minimum 3x/day. 10 minutes and done. Don’t short cut this stuff. It’s boring but it works, especially if your symptoms worsen as the day goes. It’s now easier than ever to smuggle an ice pack into the office fridge and wear compression gear under your dress clothes. Use that to your advantage when working to heal an injury!

The second goal is going to be to loosen up the injured area. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! Healing a tendon injury isn’t about no pain, no gain. The muscle needs to heal! Don’t overdo it in an attempt to speed up your recovery.

1) R.I.C.E. + gentle stretching. There should be no pain with stretching.

2) Begin using the foam roller to work on the muscles first (in other words above the tendon). The tendon is what attaches the muscle to bone. The goal here is to start getting slack into the muscle without aggravating the injury itself. No tennis ball work or active/joint mobilizations. The order should be foam roll the muscle above the tendon -> stretch -> RICE.

3) Begin using the foam roller over the tendon to tolerance. The order should be foam roll the muscle above the tendon-> over the tendon -> stretch -> RICE.

4) Begin using the tennis ball for cross friction. Remember, you will want to work perpendicular to the the tendon. Start with light pressure at one end of the tendon and work your way all the way down it. Repeat as needed (and as tolerated) with increased pressure. If it’s too painful- wait and try again the next day. The order should be foam roll the muscle above the tendon -> over the tendon-> cross friction -> stretch -> RICE.

How long do you need to R.I.C.E for??? Until it’s 100% gone.

Step 3: Specific tendon locations

Now that you know how to treat specific tendon injuries, the next step is being able to accurately locate them. The cross friction technique requires you to work perpendicular to the direction of the tendon. This prevents you from causing further damage to an already injured area. In the two links below you will find the common sites for tendonitis, how to find (palpate) the tendons, and what direction you should do the cross friction on. Due to the volume of material, we are going to break it down into upper and lower body.

Lower Body

Upper Body

Step 4: Training Modification Tips

More often than not, the first question I get is not- what do I do to get this better? It’s what can I do while I get this better? To answer this question, I put together a chart that will help you grade the severity of your injury based on your symptoms, make appropriate training modifications, and determine what course of action is best in terms of medical treatment. Think of it like a giant thermometer. The higher up you move on the chart, the more important action is and the more likely your training and racing will take a hit.

***I can’t stress this enough- use common sense when using this chart. This is not all encompassing and it is not designed to keep you from your healthcare team. If you are experiencing symp- toms like numbness/tingling, swelling, scary dark/purple bruising,inability to stand/weight bear, lift your arm over your head, etc please call your Doctor.***