August’s Physiotherapy Tip of the Month is a follow on from July’s tip on Tendon injuries. For this month’s piece we are going to focus on rehabilitation after a tendon injury; typical timelines and the most effective strategies. Rehabilitation from all stages of tendon injuries- it is notoriously slow! Tendons have a poor blood supply and this prolongs the healing process. Studies have shown that it takes up to 3 months for a tendon to display structural improvements in response to strengthening exercises. Recovery times will also differ depending on the level of injury in the tendon tissue and how long it has been problematic for.
The level and intensity of exercise that you do will be guided by your physiotherapist depending on the severity and irritability of your pain. It is acceptable that the exercises may be uncomfortable but they should not aggravate your pain and leave you sore for hours after their completion.
The first stage in tendon rehabilitation usually involves settling down the symptoms and decreasing the intensity of the pain. This may involve up to 4 weeks of relative rest by avoiding the provocative activities. It is important to note that relative rest is recommended as opposed to complete rest. This is because complete rest can cause the tendon to actually stiffen and weaken. In fact, a good rule of thumb for all tendon rehabilitation is that tendons do not like complete rest! Sometimes, it is beneficial to take anti inflammatory medication at this stage to settle the symptoms. Your physiotherapist will prescribe appropriate exercises to keep some degree of movement in the joint and associated joints during this phase.
The next stage of tendon rehabilitation generally involves working on range of movement and joint mobility. It is important that the muscle and joint complex has close to full movement before strengthening exercises are commenced. Interestingly, static stretching is not recommended for a tendon injury as this can actually aggravate symptoms.
The first stage of strengthening exercises is isometric exercises. These are exercises where you work the muscle group but do not move the joint. An example of an isometric exercise would be squeezing your thigh muscle and pressing your leg down into the bed. Isometric exercises have been shown to have a pain relieving effect for tendon injuries. Your physiotherapist will prescribe these exercises based on the irritability and severity of your pain.
The next progression of rehabilitation is to concentric exercises. These are the most common form of exercises and involve using the muscle to move the associated joint. A simple example would be lifting your arm up overhead. These exercises place more load on a tendon than isometric exercises and are generally more challenging but they can bring greater tendon improvements.
The next rehabilitation stage is a progression to eccentric exercises. These are the generally the most difficult exercises but are essential in fully rehabilitating a tendon injury. An example of a simple eccentric exercise would be lowering your arm from a height- using your muscles to control the movement. When you are walking downhill you are eccentrically working your quadriceps muscles at the front of your thigh.
Once you have built up the movement and strength in your muscle and tendon, you should be ready to return to some activity or sport specific exercises. For example, for Achilles tendon rehabilitation this may include drills, jumping and hopping. It is very important that you do not progress to this stage too quickly as it could undo your good work thus far. Your physiotherapist will guide you through this stage of rehabilitation to ensure that you are ready to return to your sport or activity.
If you think that you could be struggling with a tendon injury, here at the Bon Secours Physiotherapy Department, we would be happy to meet and assess you. All of our physiotherapists are Chartered and are CORU Registered. We are continually training and upskilling so we can provide expert care for Sports Injuries, Pain Management, Vestibular Rehabilitation, Bone Health & Osteoporosis, Hand Therapy and Orthopaedic Issues.