To start with, we need to take a closer look at biology! A tendon is a fibrous structure that connects muscles to bones. It transmits the force created by muscular contraction to the skeleton, producing movement.
Tendons are made up of collagen, glycoproteins and proteoglycans that form microfibrils and contain around 70% water, which is essential for the regularity of the microfibrils. These microfibrils group together to form fibres, which are then assembled to form bundles. These bundles are aligned lengthways along the tendon for greater strength.
Tendons have very little blood supply. They are surrounded by a membrane, the epitenon, and are housed in a sheath (the paratenon) which protects them and produces a lubricating liquid that helps the tendon slide through the sheath
Like the skeleton, tendons are constantly being remodelled: new fibres replace old ones. This phenomenon of cellular renewal is due in particular to the nerve receptors contained in the epitenon, which signal the tension of the tendon to the brain, as well as the nature of the movement performed. In this way, it contributes to the perception of our body in space and the maintenance of our posture and balance. It is this same mechanism, as part of a well-executed sports training programme, that enables muscle fibres to be recruited to increase mass and strength.
Conversely, unusual repeated effort on a tendon that has undergone little or no training and is poorly warmed up weakens its structure, particularly at the ends of the tendon and in the area where the greatest tension is exerted. A sedentary lifestyle and age tend to make tendons more fragile, and this is where tendon pathologies appear!
So tendonitis, tendinopathy or musculoskeletal disorder?
The common term "tendonitis" is not entirely correct, because except when the sheath of a tendon is inflamed, there is no inflammation as such. However, the suffix "-ite" indicates inflammation of an organ. The term "tendinopathy" ("tendon disease") is therefore preferable.
All parts of the tendon can be affected: the body of the tendon (tendinopathy proper) or the part connected to the bone (insertional tendinopathy or "enthesopathy"). Sometimes, it is the sheaths surrounding the tendons, in which they slide, that are affected. This is known as "tenosynovitis".
Musculoskeletal disorders (MSDs), often referred to in the context of occupational health, include tendinopathies as well as muscular and joint disorders
How does tendinopathy develop?
Tendinopathies are caused by tendon fatigue: repeated stress and insufficient rest between stresses. The damaged fibres swell, the tendon thickens and the synovium (the liquid that lubricates them) changes. The thickened tendon no longer slides easily in its sheath, and the resulting friction causes pain and muscle contractures in the damaged area.
Tendinopathy generally occurs as a result of prolonged stress (intensive use of a computer keyboard or piano, knitting, gardening, prolonged walking or too intense sports training) or because the tendon rubs against a bone or in a sheath that is too tight.
Most sports-related tendinopathies are due to excessive training, lack of or inadequate warm-up, poor technique, prolonged repetition of the same movement, unsuitable or badly adjusted equipment, unbalanced diet and dehydration.
But certain diseases can make tendons more fragile: diabetes, obesity, excess cholesterol or uric acid, dental infection, Lyme disease and other infectious diseases transmitted by ticks, brucellosis, etc.
In addition, smoking, because it reduces the vascularisation of tendons, also contributes to the appearance of tendinopathies.
Finally, certain treatments are also likely to cause tendinopathy: antibiotics, cortisone injections, anabolic drugs ("steroids"), statins (to combat excess cholesterol), for example.
How can you protect yourself?
BEFORE EXERCISE, A WARM-UP IS ESSENTIAL
Ten minutes are needed to prepare the tendons, and the frequency and intensity of the exercise should be progressive. It should become an automatic, a sort of ritual that precedes exercise!
DRINK REGULARLY TO PREVENT DEHYDRATION
During exercise, the body needs water to compensate for losses due to perspiration, breathing and energy production. Insufficient hydration before, during and after exercise can have a number of consequences, both benign and serious: tendinopathy, cramps, discomfort, heat stroke, etc.
EQUIP YOURSELF CORRECTLY
Good training equipment is essential to prevent sports-related accidents and illnesses. For example, shoes suited to the sport, the terrain and the athlete's weight and feet greatly reduce the risk of developing lower-limb tendinopathy.
STRETCH YOURSELF!
A sports session should be complemented by a stretching session. As well as helping you to calm down, stretching after sport helps to prevent tendon and muscle problems by improving muscle perfusion and drainage.
TAKE REGULAR BREAKS
Whatever activity you do (sport, gardening, DIY, etc.), take regular breaks between activities that involve repeated movements.
If, despite all this advice, you develop tendinopathy, here's our advice:
In the acute phase, spare or immobilise the tendon and its sheath with an elastic bandage, for example.
Don't forget: rest is one of the most effective treatments for relieving tendinopathy!
Rest must remain relative, however, and work of progressively increasing intensity, under the supervision of a physiotherapist as part of functional re-education, is necessary. The aim is to stimulate the formation of new, functional collagen fibres (perfectly aligned lengthways along the tendon).
Cold (cryotherapy) soothes pain, while heat encourages inflammation. Place an ice pack over the inflamed area. Place a damp cloth between the ice pack and the skin to avoid burning yourself. Do not apply for more than twenty minutes at a time, with twenty minutes at room temperature between two successive applications.
Green clay poultices (link to July's article on clay) can also provide relief. Wrap the poultice in cling film to prevent the clay from drying out and losing its qualities.
Osteopathic treatment is recommended, particularly to correct postural problems or organic and/or joint dysfunctions that may contribute to tendinopathy.
In some cases, the doctor will prescribe medication to combat pain, stimulate healing or, if necessary, combat infllamation. Paracetamol may be prescribed in the acute phase to improve quality of life. However, they have no positive role in tendon healing and may even falsely reassure the patient that the condition of their tendon has improved (and hinder the essential rest phase). They should therefore only be used for short periods. Oral or local anti-inflammatories are reserved for pain caused by inflammation of the sheath that protects the tendons (tenosynovitis). In other, more common cases, their use is of no benefit. The application of an anti-inflammatory cream or gel (NSAID) may be suggested. This can relieve pain without the side effects of oral NSAIDs. Most of these local treatments are available without a prescription. Gels containing ketoprofen may cause photosensitivity reactions. The areas treated with the gel must be covered by clothing to avoid exposure to the sun, even if veiled, for the duration of the treatment and for 15 days after it has been discontinued.
In the most serious cases, surgery may be indicated.
In the case of multiple tendinopathies (involving several tendons), it is likely that metabolic acidity is the cause. In this case, it is advisable to lower the pH of the tissues by taking mineral salts, particularly zinc, in association with a phytotherapy drainage based on horsetail, meadowsweet and dandelion, to encourage the elimination of metabolic waste.
Taking silicon over the long term can also help maintain tissue elasticity.
Magnetic therapy can be an ally on several levels. Thanks to the magnetic field created by powerful magnets, it helps to :
- Reduce pain and improve movement
- Increase blood flow to the painful area, helping to relieve it
- Stimulate the secretion of melatonin and growth hormone, thereby contributing to healing.
However, it is essential to consult a doctor to identify the cause of your tendinopathy and provide the most appropriate treatment.
Magnetised water is also recommended for drainage and tissue hydration.