No matter what type of sport you play or fitness training you do, tendon injuries are a threat and one of the most common types of injury athletes have to contend with. Tendons are thick bands of connective tissue that bind muscle to bone. The most common tendon problems fall under the class of tendinopathies, a group of conditions characterized by overuse. Tendonitis and tendinosis fall into this category of tendon-related issues.
What Are Tenonopathies?
Tendonitis refers to inflammation and small microtears in a tendon, usually due to overloading the tendon or forcing it to handle a force it’s unaccustomed to. Tendonosis is a condition more closely related to tendon deterioration, or the breakdown of connective tissue fibers. This deterioration is a response to chronic overuse and lacks an inflammatory component. When you look at a tendon with tendonosis, inflammatory cells are absent. Much of what people think of as tendinitis is actually tendonosis, with true tendinitis being rather rare.
Tenonopathies are common in runners, but people who weight train also have to deal with the discomfort and inconvenience of tendinopathy. The time when a tendon injury is most likely to strike is when you change your level of training abruptly or suddenly increase the intensity or duration of your workouts. That’s why the recommendation to gradually boost the duration and intensity of your workouts is a time-tested one.
Tendonopathy Can Become Chronic
Both tendonitis and tendonosis can cause weeks or even months of pain and stiffness. The discomfort of tendinopathy is usually worse in the morning and when you stretch on the affected tendon by moving it. Unfortunately, tendonopathies can throw a major wrench in your workout plans, forcing you to modify the exercises you do, or you can work out at all. If you’ve ever had a bad case of Achilles tendonitis, which is more likely tendonosis, you know how encumbering the symptoms can be, how you have to modify your workout and how long the symptoms can stick around. Contrary to popular belief, tendonopathies don’t generally heal in a few weeks but can take several months to resolve. Just as troubling is the fact that once you’ve had a tendinopathy, the tendon is more prone towards injury in the future.
Another common area for tendinitis and tendinosis to strike is the extensor tendon of the elbow, what we think of as “tennis elbow.”
Preventing Tendinopathies: What Role Does Stretching Before a Workout Play?
You often hear that it’s important to stretch out a tendon to elongate it to help prevent tendon injury. Theoretically, this should reduce the tension on the tendon and increase flexibility. Now a new study from the University Medical Center Groningen in the Netherlands finds that stretching not only doesn’t lower the risk for tendon injury, but it could also actually increase it.
After reviewing a variety of studies and articles looking at ways to prevent tendinopathy, researchers found no evidence that stretching reduces the risk for tendon injuries and may be detrimental for people who have knee problems or chronic tendon issues. Stretching increases the compliance of the muscle-tendon unit, making it more flexible, but there’s little evidence that this reduces the risk of tendon injury. Plus, research also shows doing static stretches before a workout reduces power. That’s why most trainers recommend a warm-up of general movement drills and dynamic stretches to increase body temperature prior to working out and to save static stretches for the cool-down period.
What Can You Do to Prevent Tendon Injury?
One intervention that’s gaining favor for treating tendinopathies is eccentric strengthening of the tendon and muscle. Eccentric strengthening exercise boosts collagen production in the tendon and the laydown of new connective tissue. As a result, the tendon becomes stronger and more resistant to injury. As you may know, an eccentric contraction is the portion of a strength training exercise where the muscle lengthens against resistance. An example would be the “lowering” phase of biceps curls, where you’re bringing the weights back down.
Eccentric contractions place the most stress on muscles and tendons, and it’s this stress that causes new collagen fibers to be laid down and, hopefully, make the tendon stronger and more resistant to injury. In effect, the tendon undergoes a remodeling process in response to the stress of eccentric training. Research suggests that 12 weeks or more of progressive strength training that emphasizes the eccentric movements can help rebuild a damaged tendon. Eccentric training also makes tendons more resistant to future injury. Although the current study didn’t find strong support for eccentric strengthening as a way to prevent tendon injury, other studies are supportive.
Other Ways to Prevent Tendon Injury
The researchers in the current study found support for wearing shock-absorbing shoe insoles during exercise for preventing Achilles tendinopathies. This would be particularly important for some runners prone towards Achilles tendinopathy due to the stress they place on their tendons as their feet strike the ground. Because there are so many variations in foot anatomy, flat feet, high arches etc, it’s best to get a foot evaluation and a custom orthotic, if needed, rather than buying a “one size fits all” orthotic at a drugstore.
They also found some evidence that hormones play a role in preventing tendinopathies in women. Post-menopausal women on hormone replacement therapy seem to have a lower risk for tendon injury, although that shouldn’t be the deciding factor when choosing whether to replace hormones after menopause. Research suggests that estrogen may modify the structure of tendons. Being overweight or obese and aging is all correlated with a greater risk for tendon problems.
The Bottom Line?
Stretching may not protect against tendon injury as much as originally thought, although this is only one study. The best plan of action may be to wear appropriate shoe wear, warm-up dynamically before a workout, don’t suddenly increase the intensity or duration of your training, vary the type of exercises you do, and train with an emphasis on eccentric movements to strengthen your tendons.
References:
Int J Ther Massage Bodywork. 2012; 5(1): 14-17.
The Physician and Sports Medicine. VOL 28 – NO. 5 – MAY 2000. “Overuse Teninosis, Not Tendinitis”
Rheumatology (2008) 47 (10): 1444-1445.doi: 10.1093/rheumatology/ken337.
Sports Med. 2004;34(7):443-9.
Br J Sports Med. 2007 Apr; 41(4): 224-226.doi: 10.1136/bjsm.2006.034165.
J Strength Cond Res. 2006 Nov;20(4):804-10.
J Can Chiropr Assoc. 2011 Dec; 55(4): 269-279.
Foot Ankle Int. 2006 Nov;27(11):952-9.
Medscape Family Medicine. “Stretching Won’t Prevent Tendon Injuries” April 20, 2015.
Related Articles By Cathe:
Factors That Increase Your Risk for Tendon Injury
Does Weight Training Make You Less Flexible?
The Process to Start Rehabbing an Achilles Injury
Can You Strengthen Your Tendons?