Author: Rebecca Steele

Why Do Tendon Injuries Take So Long to Heal?

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If you have ever suffered from a tendon injury you will know that the recovery can be frustratingly long. Tendons are important tissues of the body, connecting muscles to bones and come in many different shapes and sizes. There are many reasons why tendon injuries can be difficult to treat, as we explain below.

Tendon injuries often develop gradually.

Tendons need to be able to transmit forces from muscles to the bones that they attach, however they respond to changes in strength more slowly than muscles do. As muscles become stronger or take on more load, the tendons can fail to keep up with this increased demand becoming painful and damaged. This process can take a while to occur and often changes to tendon tissue has begun long before the pain is noticed. This means that there are likely to be multiple factors to be assessed, including biomechanics and training regimes before the problem can be resolved.

Tendons have limited blood supply

Tendons do have their own blood supply, however, it is not abundant as muscles and this can be a factor with healing as all tissues require nutrients for health and to heal. Any condition that compromises circulation, such as diabetes, can predispose tendons to injury and delayed healing.

Rest and stretching may not necessarily help.

Our instincts in response to tendon pain may not help with recovery. In some cases, stretching can aggravate symptoms and while rest may reduce symptoms, it will not necessarily help with recovery. The best evidence for promoting healthy tendon growth is through addressing poor biomechanics and a tailored strength and loading program.

Recovery often relies on adherence to a specific rehab program.

One of the biggest barriers to healing tendon pain is that exercises can be easy to do in theory, but hard to do in practice. They can take time and discipline. Your physiotherapist can also help you to find strategies to fit your exercises into your daily routine if you are finding this difficult.

Tips for Managing Tendon Injuries

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Tendons, the soft connective tissues that join muscles to bone are known for being notoriously difficult to treat once injured. The reason for this is that often they are injured through stress or overuse, and compared to muscles have relatively small blood flow, which is essential for healing. 

 

Tendons and muscles work together to move your joints and are called a contractile unit. As muscles are exercised and gain strength, the attaching tendons are also placed under tension and adapt to this to become stronger. If the load placed on the tissues exceeds their capacity, the tendon fibres can begin to break down and become stiff and painful. 

Is my pain related to a tendon injury?

For an accurate diagnosis, you will need to be assessed by a physiotherapist. However, some signs that your pain might be coming from an in issue with your tendon are; 

  • The pain is quite specific and can be felt over the tendon itself. 
  • The pain is worse when under stress and improves when rested. 
  • The pain improves after exercise has started, but it might be worse the day after. 
  • The area around the tendon may feel stiff after periods of rest, particularly in the morning. 

How are tendon injuries treated?

When it comes to recovery, tendons are often treated differently to other injuries. While each tendon injury is unique and will require assessment and intervention by a physiotherapist, there are a few general approaches that usually help with all tendon injuries.  

Reducing your activity to a comfortable level is the first step to recovery. Complete rest can actually delay healing as the tendon simply becomes weaker and less able to cope with subsequent loads. Your physiotherapist can provide you with a targeted exercise program to aid your recovery. Eccentric exercises, which are exercises that work alongside gravity, have been shown to stimulate tendon healing and strength.

Stretching may aggravate your injury and should be used with caution. Assessment of any biomechanical faults or stresses that are placing undue load on the tendon is also a central component of treatment. Your physiotherapist is able to guide you with your recovery and return to sport to avoid aggravating any injury. 

The information in this newsletter is not a replacement for proper medical advice. Always see a medical professional for an assessment of your condition. 

Acute Wry Neck

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Have you ever woken up with an inexplicably stiff and painful neck that will only turn to one side? You might have been suffering from acute wry neck, a painful condition following a typical pattern of symptoms. In the clinic, wry neck is classified as one of two different types – Facet or Discogenic wry neck. 

Facet Wry Neck:

Facet joints are found on either side of the spine and allow controlled rotation and side bending of the neck. An awkward or sudden movement of the neck can cause a part of the joint capsule to tear or get caught in the joint, making it feel locked. The muscles around the area can also become tight and spasm, which amplifies the pain. The pain is usually sharp and can be pinpointed quite accurately to the part of the neck causing the problem, and the pain rarely travels down into the arm. It is usually possible to find a resting position where the pain goes away completely, only having pain when turning in specific directions. The good news about Facet Wry Neck is that your physiotherapist is usually able to help you ‘unlock’ the neck quite quickly with gentle mobilisations. Most of the time, a full recovery can be expected within a week. 

Discogenic Wry Neck: 

The vertebrae of the neck are separated from each other by fibrous discs, filled with a gelatinous centre. These discs provide support, flexibility and shock absorption. When placed under pressure, these discs may bulge or tear, and the resulting swelling can cause pain and muscle spasm in the surrounding area. It is important to note that in an area as sensitive as the neck, a small amount of damage can result in a large amount of pain. 

 

The development of discogenic wry neck is usually due to a combination of factors, including neck stiffness, poor posture and biomechanics than can contribute to the disc being vulnerable prior to the injury. In this case, it can be challenging to find a comfortable position, and it is more likely for the pain to travel into the arm and include pins and needles.

 

Treatment of discogenic wry neck is focused on reducing pain and muscle spasm with massage, taping, heat and postural education. Further treatment aims to reduce any stress that is being placed on the disc, mobilise any stiff spinal segments and correct any muscle imbalances. While the initial symptoms may settle down quite quickly, it can take up to six weeks to fully recover from discogenic wry neck. In this condition, it is also essential to address all the factors that may cause a recurrence of the issue.

What Is Frozen Shoulder?

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Frozen shoulder, also known as adhesive capsulitis, is a condition affecting the joint capsule of the shoulder. It is characterized by inflammation of the capsule, leading to pain and stiffness with shoulder movements. 

 

Frozen shoulder is categorized as either primary or secondary. Primary frozen shoulder occurs for no clear reason, while secondary frozen shoulder develops following an injury or surgery of the joint. 

Frozen shoulder usually follows a typical pattern and can be separated into three stages, freezing, frozen and thawing. The pain begins in the freezing stage as an ache or twinge with movements. The pain gradually increases, and the shoulder begins to feel stiff as well as painful. Usually, shoulder movements away from the body or rotating outwards are the most painful and restricted. 

 

As the condition progresses, everyday activities can be significantly impacted, with activities such as dressing, grooming, reaching overhead and behind the back becoming difficult. Lifting heavy objects can be very painful, and the pain is often felt at night-time, interrupting sleep. The three stages follow a typical pattern; 

 

Freezing – Pain is present at rest/night, increasing pain and stiffness with shoulder abduction and external rotation. 

 

Frozen– Pain starts to lessen, but the stiffness of the shoulder joint increases.

 

Thawing – Pain reduces to lower levels and movement begins to return.

 

Frozen shoulder will usually resolve on its own without any long-lasting stiffness. However, complete recovery does not always occur. 

 

Frozen shoulder usually affects people over the age of 40 and women are affected more often than men. While no definite cause has been identified, there are some factors that increase the risk of developing a frozen shoulder. These include diabetes, prolonged immobilization, trauma, stroke, thyroid dysfunction, heart disease and autoimmune disease.

 

The early stages of frozen shoulder can mimic other shoulder conditions, and these should first be ruled out by a thorough examination. While frozen shoulder is a self-limiting condition, meaning it will resolve on its own without treatment, this can take up to 2-3 years. Physiotherapy during this time focuses on reducing pain as much as possible and helping patients to cope and adapt to their symptoms during the freezing and frozen stages. 

 

As the condition moves into the thawing stage, physiotherapy aims to help restore strength, movement and control to the shoulder. The entire process can be extremely distressing for patients and providing support and education as they move through the stages of the condition is an essential part of treatment. 

 

If you have any concerns about shoulder pain that is not resolving, come and have a chat with one of our physiotherapists to see how we might be able to help you. None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your injury. 

 

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