SO HOW DO TENDON INJURIES OCCUR?īefore we go into how to treat tendon injuries, we first need to dive a little deeper into how the injury process occurs. Therefore, when we speak about tendon injuries, it is advised to now use the term “tendinopathy” rather than “tendonitis” and “tendinosis”. 13 Furthermore, leading researchers in the field of tendon injuries now believe “tendonitis” and “tendinosis” are not mutually exclusive and are actually different parts of the same injury process.
However, recent research has challenged the idea that the inflammation commonly seen with tendon pain is a main driver of the injury and pain. Commonly medical practitioners will throw out the word “tendinitis” when referring to a recently painful injury and “tendinosis” when referring to more chronic long-term tendon injuries.
The “osis” ending of tendinosis traditionally means the problem is not caused by inflammation but due to the tendon itself degrading and becoming weak. 2 The “itis” ending of tendinitis refers to an acute injury caused by inflammation. Historically, tendon injuries have been separated into two distinct categories: tendinitis and tendinosis. However, patellar and quadriceps tendon pain are both prevalent in sports such as weightlifting and CrossFit due to the high forces that are sustained during the repetitive ballistic movements of the snatch and clean. Of the two, the patellar tendon is usually the more commonly injured. Historically, this is why sports such as basketball and volleyball that involve a high amount of jumping have such a high incidence of this injury (a reason why this injury is also known as “jumper’s knee”).
Movements that use the tendons of the knee as a spring (such as a jump) place significantly more load on the tendon than a slower movement like a squat. Young athletes (under the age of 30) who are involved in sports that include sudden explosive and repetitive movements of the knee are most susceptible to developing an injury at either the quad or patellar tendons. A spark is lit and the injury process begins.
When this occurs the process tips from being adaptive to pathological. 27 However, if the load placed on the tendon is too extreme or if there is inadequate recovery in the athlete’s training program, this balanced process is disrupted. Training loads placed on the tendon that do not severely exceeded this set level create a cellular response in the tendon (that can actually be seen by ultrasound) that will return to normal in 2-3 days given proper recovery methods (this is the normal time frame for the adaption “replenishment” process to take place). Depending on a number of factors (such as how intense you have trained throughout your years as an athlete, the medications you take, whether or not you have diabetes, etc.) your body will have adapted your tendon to a certain set point of strength called the “load tolerance” level. Tenocyte cells react to the forces and loads placed on the tendon and adapt the cellular make-up of the tissue accordingly (called the extracellular matrix). In your tendons, this process is largely controlled by small cells called tenocytes that are dispersed amongst aligned fibers called collagen (type 1 if you want to be exact). Overtime this natural replenishing process is how strength is built. Every time you place stress on your body (like when working out) portions of your tissues are degraded and then regenerated. These two tendons work together to absorb and release tremendous power (with movements such as jumping) much like a spring.Įvery single day the tissues of your body (muscles, tendon and even bone) are in a constant process of fluctuation. Above the kneecap is another band of fibrous tissue, the quad tendon, which attaches to the very large and strong quadriceps muscles. The patellar tendon runs from your kneecap (patella) to the tibial tuberosity (the prominent bony part of your shin bone). How does someone develop patellar or quad tendon tendon pain? To answer this question, we first have to discuss a little anatomy.Ī tendon is essentially a fibrous band of tissue that connects muscle to bone.