Optimal Loading for Tendon Rehabilitation

As a physiotherapist having many clients with tendon issues, the biggest question I have is why did injury occur in the first place? Was it due to trauma, is it linked to training loads or is it something else causing effects to the tendons. Our job is to help guide you to have the best rehab getting you back into your sport or activities. This blog will discuss the importance of optimal loading for tendon rehabilitation.

Optimal loading is what physios strive to achieve when talking about rehabilitation, although due to the nature of tissue healing and recovery it can be made difficult to follow a ‘recipe’ program. Therefore we need to adapt our exercises and progress you through the rehabilitation process to get you back to the top of your game.

When deciding what rehab pathway is appropriate we must first look at what stage of injury we are in. There are two key stages of tendon injury, reactive and degenerative. A Reactive tendinopathy can be described as an acute tendon injury where appropriate management strategies would be to de-load the tendon to let the inflammatory process settle down, then proceeding with progressing tendon loading. A degenerative tendon is where symptoms have been present for a while. A good progressive loading program to increase tissue capacity and tolerance to load is needed.

The table below describes the nature of these types of injuries:

Reactive Degenerative
Symptom Acute onset of symptoms, slow to settle down Chronic – long history of symptoms
Age 15-25 30-60
Time 2-6 weeks 3-6 months
Physio management Massage, orthotics, Dry needling etc. Progressive load
Treatment Unload and reload Load,- Heavy and slow

The image below can help us understand the architecture of a tendon. As a tendon injury starts to proceed into a degenerative tendon the striation of the collagen go from being very linear and to being disrupted and become more disorganised.  This demonstrates the change that occurs and therefore it is important to have an appropriate exercise program to prevent further injury.

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Here at Bureta Physio we can help guide you through your injury. We will focus on the injury itself but always ask the question to why this occurred in the first place.

Key points:

  • Depending on the type of injury, we need to work together to establish the best management strategies for rehab
  • Acute reactive tendons may need to be unloaded prior to reloading
  • Chronic degenerative tendons can take months to heal fully
  • As a degenerative tendon develops the architecture of the collagen fibres becomes disorganised. Through loading appropriately we can enable the tendon to be able to adapt to required loading and therefore allowing return to sport.

Please call us on 07 576 1860 to discuss your injury and our team will be more than happy to help.

Written by Braedon Catchpole – Physiotherapist

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