03 Abr Patellar Tendinopathy: How to recover from this injury?
After experiencing chronic patellar tendinopathy, I want to share with you a little about how the recovery process is from this injury that can become complicated.
What is a tendon and what is its function?
Before starting the rehabilitation, you must understand what a tendon consists of and what function it has. A tendon is made up of dense fibrous connective tissue made up primarily of collagen fibers. The primary collagen fibers are the basic units of a tendon. (Basso et al., 2001). It is a tissue capable of resisting high tensile forces while transmitting forces to the skeletal muscle assembly. In addition, the tendon is flexible so that joint movement can bend with it, along as acting as a shock absorbent and limit potential muscle damage. The tendon also shows a degree of extensibility. If the tension used to stretch a tendon could be recovered, a beneficial elastic effect would be achieved. The muscles lengthen and shorten cyclically. During the elongation period, elastic energy can be stored and used as elastic recoil. (Kirkendall & Garrett, 1997).
WHAT IS IT AND WHAT CAUSES TENDINOPATHY TO HAPPEN?
A tendinopathy is when there is damage to the tendon fibers, where pain and loss of strength and function of different actions of a joint begin to occur. The origin of this inflammation or degeneration of the tendon is multifactorial. From poor load handling, little rest, biomechanical deficiencies, neuromuscular deficiencies, etc. (Riley, 2008).
HOW SHOULD TENDINOPATHY BE TREATED?
This is still one of the topics to be debated, as there are many misunderstandings on how to recover a tendon. It should be noted that the use of cortisone injections has no benefit, as does the use of anti-inflammatories such as ibuprofen. The inflammation process of a tendon is necessary to regenerate those affected tendon fibers. (Riley, 2008). Today there is a physiotherapy intervention that has had good results in several cases, it is the intracutaneous percutaneous electrolysis (EPI). In short, it is a galvanic current through an acupuncture needle that produces a local inflammatory process allowing phagocytosis and the repair of the affected soft tissue (Valera-Garrido, 2010). Now, it is important to say that by itself this type of intervention is not very effective, since it must be remembered that the tendon is made to resist load. So in the same way that it was injured it recovers, by loading it.
WHAT TYPE OF LOAD / TRAINING IS NECESSARY TO RECOVER THE TENDON?
It is necessary to load the tendon under strength training, and the method used is known as heavy slow training (Wiesinger, 2019). There is a lot of talk about eccentric training, but it falls short since the tendon must also do the concentric action of a movement. The load must be handled depending on what the person can bear, it is not about producing pain. It is normal to have a little discomfort, but not aggravating. This type of training will cause inflammation of that injured tendon, which will initiate a process of regeneration of the damaged tissue. Therefore, it is important not to take anti-inflammatories, it would slow down and negatively affect recovery work. After training, rest is necessary. 32 to 48 hours of rest are recommended between each training session. Studies recommend 12 weeks of this type of training to recover the tendon, however this depends on the case, it will not always be so. (Wiesinger, 2019).
HOW WAS MY RECOVERY?
Now I want to talk about my recovery and what it feels like to live it. I can sit down to write about what the studies say and put all kinds of scientific references, but I think it is also necessary to get out of the laboratory and comment on a real case, so you can understand the importance of individualizing each case.
I started with a meniscus tear in the anterior horn. From there I had surgery that didn’t go well and I also had a bad rehabilitation program. At this time I was still competing in swimming and triathlons. A month after I returned to the sport I had to leave it because of intense pain that would not let me walk, sit, and even sleep well. This led to creating a very chronic tendinopathy in both patellar tendons. I spent all of 2017 looking for a way to recover from this injury. I was very muscularly atrophied and unable to move well biomechanically. Not to make the story too long, with a group of professionals I was guided during a process that lasted more than a year. My goal was to go back to running, swimming, surfing, skiing, being an active person like I have always been. So I had to start from scratch. And as a result of this I learned that a tendinopathy is more than adding load to a tendon. It is necessary to understand the function of the foot, the importance of a stable foot, strong, useful, and as a huge protector of the knee. This leads me to the hip, since it is important to have good mobility and neuromuscular control. A hip with deficiencies sooner or later can affect the knee. Learning the importance of this made ¨heavy slow training¨ effective, since it strengthened him more than the structures near the knees.
It is necessary to see the body as a whole and not individually, it is a great mistake to think that a knee problem happens only because of something close to the injury. Most of the time an injury happens because of something far from the injured point.
Today I manage to do the activities that I like, and I am always doing everything possible to take care of my body, especially after having suffered such complicated injuries. I learned to run, to swim better, (yes, technically better than when I competed in college), I learned to train and listen to my body.
Finally I want to highlight in this blog, the importance of training being focused on the locomotion of the human being. In the end we walk, run, jump, push, rotate, pull, resist forces, etc. A rehabilitation of an injury is more than recovering a tissue, it is teaching the body to work together in harmony, this will make you recover and live a healthier life.
Basso, O., Johnson, D. P., & Amis, A. A. (2001). The anatomy of the patellar tendon. Knee surgery, sports traumatology, arthroscopy, 9(1), 2-5.
Kirkendall, D. T., & Garrett, W. E. (1997). Function and biomechanics of tendons. Scandinavian journal of medicine & science in sports, 7(2), 62-66.
Riley, G. (2008). Tendinopathy—from basic science to treatment. Nature clinical practice Rheumatology, 4(2), 82-89.
Valera-Garrido, F., Minaya-Muñoz, F., & Sánchez-Ibáñez, J. M. (2010). Efectividad de la electrólisis percutánea intratisular (EPI®) en las tendinopatías crónicas del tendón rotuliano. Trauma Fund MAPFRE, 21(4), 227-236.
Wiesinger, H. P., Kösters, A., Müller, E., Seynnes, O. R., Herfert, J., Hecht, S., & Rieder, F. (2019). Efficacy of heavy slow resistance training in management of patellar tendinopathy: A single blinded randomized controlled trial. In Congress of the European College of Sport Science (ECSS). Prague, Tschechien. Band 24.