If you’ve been training for a while, you’ve probably had a tendon injury at some point or maybe even more than once. If you play sports, your risk of tendon problems is even higher. According to American Family Physician, 30% of athletic injuries involve injuries to tendons. The most common sports-related tendon problem is tendinosis, sometimes called tendonitis. However, tendonitis is a more acute condition marked by inflammation whereas tendonitis tends to be a chronic problem that often recurs.
The term tendinosis has become the preferred term for non-specific pain in a tendon, as it best describes what’s happening at the microscopic level. Research shows that chronic tendon pain due to overuse is marked by degeneration rather than active inflammation. The tendon structure begins to degenerate due to repeated stress on the tissue. Although there isn’t necessarily inflammation, that doesn’t make it less painful or inconvenient!
Some people are at higher risk of developing a chronic tendon injury, like tendinosis, than others. In fact, there are five risk factors for chronic tendon injury you can control and four you can’t. Let’s look at each one and see what you can do to lower your own risk of chronic tendon pain.
Tendon Injury: 4 Factors You Can’t Control
The risk of developing a chronic tendon injury goes up with age. As the years’ pass, tendons become less elastic and more prone to injury. In fact, a study found that tendons become less effective at repairing themselves with age. Research shows that damaged protein fragments build up within the tendons later in life, suggesting that the repair process is not as good as it should be. We can’t stop the aging process, but we can modify our training to be more tendon friendly. Plus, it’s important to warm up properly and stretch at the end of a workout.
As with many health issues, genetics are a factor in the risk of developing tendinosis. In fact, a 2012 study found that a family history of tendinopathy, a collective term for tendon injuries, was linked with a 5-times higher risk of an individual developing the condition themselves.
Males have a higher risk of tendinopathy than women. According to one study, almost 84% of cases of tendinosis occur in men. It’s not clear why men are at greater risk. Some experts believe higher levels of estrogen in women offer some protection while other studies suggest that estrogen increases the risk. Others point to strong calf muscles in males and the fact that strong calf muscles place more stress on the Achilles tendon, one of the most common sites for tendinopathy.
Limb and Foot factors
If you’ve ever injured your foot or ankle, you’re at higher risk of tendinosis. Also, people with flat feet or high arches are also more likely to develop tendon pain due to tendinopathy. If you suspect you’re flat-footed or have a high arch, visit a podiatrist or sports medicine physician and get a professional assessment. It can save you from an unexpected tendon injury.
5 Tendon Injury Risk Factors You Can Control
Decreased flexibility and muscle imbalances are risk factors for tendinopathy and tendon injuries. A muscle imbalance is where one muscle is stronger than its opposing muscle. Lack of balance in training, for example, working the vanity muscles in the front more than those in the back, contribute to muscle imbalances. To lower your risk of tendon problems, do as many pushing exercises as you do pulling. Focus as much on the muscle in the front, like the biceps, as you do the opposing muscle, the triceps. Do a thorough warm-up and stretch your muscles after a workout to reduce tightness.
Don’t be too quick to buy the least expensive pair of exercise shoes. People who are prone to Achilles tendinopathy are often over-pronators. This means that when you walk or run, your foot tilts inward. If mild, this may be correctable with the right pair of exercise shoes, but sometimes you need a heel cup to elevate the heel and reduce the impact on the Achilles tendon when you walk run or jump. It’s another reason to see a podiatrist or sports medicine doctor to see what type of shoe is best for your particular gait and anatomy.
A review published in Arthritis and Rheumatism looked at a variety of studies to see if there is a link between obesity and tendon injury. In total, they looked at almost 20,000 individuals. The results showed a strong link between obesity and the risk of tendon injury. Obesity places added stress on your tendons and over time that can lead to injury. Being obese also alters biomechanics when you walk, run, or jump.
A variety of medical conditions increase the risk of tendinopathy beyond obesity. Some studies show that type 2 diabetics have a higher risk of tendinosis. Some studies also show a higher risk among people with hypertension and elevated cholesterol. Surprisingly, some medications even increase the risk. A class of antibiotics called fluoroquinolones weaken the tendon structure and can lead to tendinosis or tendon rupture. Taking corticosteroids, like prednisone, for long periods of time can too. Women taking hormone replacement therapy or oral contraceptives may also be at higher risk, although studies are conflicting. It’s another reason to control your weight, blood pressure, and lipid levels and talk to your physician about the pros and cons of medications.
How You Approach a New Activity
Another risk factor for tendinosis that you have control over is how you begin a new activity. Don’t start out with a “bang.” Gradually boost the intensity and duration of new activities. Don’t increase the distance with which you run by more than 10% per week to lower your risk of Achilles tendonitis.
The Bottom Line
Tendon injuries and tendinopathies are on the rise, especially Achilles tendinopathy. This is likely because more older people are staying physically active. Now you know some of the risk factors and can modify the ones you have control over.
· WebMD.com. “Tendonitis”
· Sports Health. 2014 Jan;6(1):41-8. doi: 10.1177/1941738113485691.
· Muscles Ligaments Tendons J. 2014 Jul-Sep; 4(3): 324–328.
· American Family Physician. Volume 100, Number 3. August 1, 2019.
· Science Daily. “Why Tendons Break Down with Age”
· Arch Orthop Trauma Surg. 2012 Jun;132(6):847-53. doi: 10.1007/s00402-012-1476-9. Epub 2012 Feb 17.
· BMC Musculoskeletal Disordersvolume 17, Article number: 16 (2016)
· Arthritis Rheum. 2009 Jun 15;61(6):840-9. doi: 10.1002/art.24518.
· Int J Sports Phys Ther. 2016 Oct; 11(5): 684–697.
· WebMD.com. “FDA Warning: Cipro May Rupture Tendons”