TENDON INJURIES DUE TO COMPRESSION

Every day Physical Therapists treat patients suffering from tendon injuries. Patients complain of pain, stiffness, and sometimes a redness or swelling near the injured tendon. Unfortunately, these injuries can occur in nearly any part of the body. In the past, medical professionals considered overuse to be the primary cause of tendon injuries but now that is coming into question.  Healthcare providers are now spending more time looking at the biomechanics of different joints and the amount of compression force that is applied to certain tendons when the joint is performing normal functional movements. In some instances, the compression force is thought to be more detrimental than the over-use of the tendon.

Tendons connect muscles to bones.  The tendon anatomy is analogous to thousands of tiny leather bands positioned next to each other and coursing in the same direction.  There are several layers of these bands of tissue and when healthy, they are capable of transmitting force from the muscle tissue to the bone. These forces are used to move the joints and when healthy, there is no pain associated with movement.

Unfortunately, tendon injuries can be caused by excess movement, repetitive motions, a rapid increase in loading and compression force. It now appears that compression could be one of the leading causes of tendon injuries.  The anatomy of some joints predisposes certain tendons to a great deal of compression which leads tissue break down. The constant compression during normal movements, reduces blood flow to the area of the tendon that is compressed. The decreased blood flow pre-disposes that area of the tendon to an injury.

The following are some of the more common sites that involve a compressed tendon due to the anatomy of the joint.

Wrist extensor tendons:  The tendons originate at the elbow and when the elbow is flexed and pronated they are compressed against the edge of the lateral epicondyle.  The other site of compression in this position can be at the radial head.

Hamstring tendons:  The upper aspect of the hamstring muscles gets compressed against the ischial tuberosity when the hip joint is flexed.  The compression can be increased and lead to more damage with prolonged sitting.

Gluteal tendons:  The Gluteus medius and minimus insert into the Greater Trochanter which is the large bony prominence on the lateral side of the hip near the pocket of a pants leg.  When the hip is flexed and adducted (the knee moves towards the midline) these tendons are compressed against the Greater Trochanter.  This can happen when someone is limping and the involved hip “drops” or moves in the form of a Trendelenburg gait. This happens in many people when they walk or run and the knee moves towards midline or into a valgus position.  Lying on the involved hip can produce an increase in compression force.

Patella tendon: The patella tendon (ligament to the true anatomist) attaches to the inferior pole of the patella.  When the knee is flexed the inferior pole is somewhat “pointy” and pushes into the tendon.

Achilles tendon:   The Achilles tendon inserts into the heel bone or calcaneus.  When the ankle is dorsiflexed the insertion point is compressed and the tendon can develop insertional tendinopathy.

The treatment of these conditions can vary depending upon the time from the development of pain to the beginning of treatment.  There other factors that determine the outcome of treatment but in most cases if the tendon injury is treated acutely the end results are much better.

Seeking the treatment from a Physical Therapist is a great idea if you develop this type of injury.   They can help to control the acute symptoms and then design and implement a program that will restore normal function of the injured body part.  Getting treatment from a Physical Therapist does not require a doctor’s prescription.

Injuries to tendons are one of the most common conditions that healthcare providers treat on a daily basis.  In the past the cause of these injuries often times centered on over-use or excessive stress placed on the tendon leading to damage to the tendon tissue.  Recently, more studies have focused on compression forces that are applied to the tendon due to the anatomy and movement of the joint.  Treatment protocols must take into account this compression force and reduce it via modified motion and movements.