Avoid Overuse Tendon Injuries:

As the weather heats up, we head outside to test our athletic prowess. We hit the road and trails on bike or foot without questioning that we may have lost some of our endurance since last fall. Tendon issues may arise during repetitive activity without proper training. Tendons attach muscle to bone and “tendonitis” or “tendonosis” is a degenerative, inflamed tendon. With tendon injury, the tendon tissues become disorganized bundles of collagen, rather than in parallel orientation and no longer function properly.  The most commonly injured tendons in the lower extremity are the patellar tendon, Achilles tendon, and the posterior tibial tendon.

The patellar tendon attaches the knee cap to the shin bone and can produce anterior knee pain with overuse. The Achilles tendon attaches the calf muscle to the heel and will cause pain along the tendon or at the heel. The posterior tibial tendon supports the foot arch and attaches the posterior tibial muscle to the bottom of the foot. Injury can weaken the foot arch causing collapse.

The best way to strengthen these areas, to prevent or recover from tendon pathology, is with ECCENTRIC strengthening. Eccentric means lengthening. By strengthening the tendon in a lengthened position the tendon properties are able to re-align in the parallel orientation making the tendon inherently stronger. The eccentric motion of these tendons is the functional position of where the tendons are at highest stress during repetitive motions. Strengthening in this position is most efficient.

Eccentric strengthening for tendon pathology has been proven is various studies to be effective. The protocol that has been used in research is performing 3 sets of 15 repetitions twice a day. The exercise varies based on which tendon you are attempting to load/strengthen in an eccentric position.

Patellar tendon = Perform single leg mini squats on an incline board. The heel should be raised, toe pointing towards the ground; keep the knee aligned over the first two toes. Only squat to 45 degrees of knee bend.

 Achilles tendon = Perform single leg heel raises off a step, focusing on slow controlled lowering motion, getting the heel lower than the step.

 Posterior tibial tendon = Perform seated with a resistance band over the ball of you foot and attached to a stable surface (band perpendicular to the outside of your leg).Resistance should be pulling your foot into an outward position. Pull the band so your foot/ankle turns inward. Again, focus on the slow controlled outward motion or back motion. Also, performing the Achilles exercise will help strengthen the tendon, since it functions in both actions.

 Before you get on your bike or lace up your running shoes to enjoy the spring sunshine, make sure your tendons are ready to handle the load. ECCENTRICALLY strengthen! Happy trails.

Lindsey Fitch is a doctor of physical therapy and running specialist at Vail Integrative Medical Group. She is an Avid competitive runner, most recently winning the Salt Lake City Marathon