Why Do Tendon Injuries Take So Long to Heal? Unraveling the Mystery

Does your chronic tendon pain seem relentless and unyielding, refusing to fade away? Is the prolonged healing process causing despair and disruption? Tendon injuries are an excruciating burden, often leading to a protracted recovery journey. They don't discriminate between tendons, making victims of the Achilles tendon in the leg, the Gluteus Medius Tendon in the hip, and even the rotator cuff in the shoulder. Yet, the question persists: Why does tendon healing feel like a marathon? 

This comprehensive blog post delves deep into understanding the nature of tendon injuries, their triggers, and the various strategies to accelerate healing. Our mission is to help you demystify the elusive process of tendon recovery and guide you towards reclaiming your health and vitality.

Exploring the Tendon Terrain

Tendons are the critical facilitators of our ability to move, serving as the bridge between muscles and bones. These hardworking structures transfer the force generated by our muscles, helping us experience the bounce, elasticity, and dynamism that underlie our movements.

Think of them as the tires on a car - they don't generate power but efficiently transfer it to the road to initiate motion. These exceptional structures adopt various forms within our bodies, presenting as cords, bands, or ribbons. Their fibro-elastic composition gives them a brilliant white appearance when healthy, reflecting their dense yet stretchy texture.

Tendons are essentially composed of cells called tenoblasts and tenocytes, enveloped by an extracellular matrix. Tenoblasts, the precursors to tenocytes, are metabolically active and transform into tenocytes as they mature. Tenocytes, stationed between collagen fibrils, produce the extracellular matrix and oversee the maintenance and restoration of tendon tissue.

The extracellular matrix consists of collagen and elastin fibers. The strength and rigidity are imparted by collagen fibers, while elastin fibers lend the necessary elasticity and recoil to facilitate dynamic movement. Different tendons possess varying collagen to elastin ratios, reflecting their specific location and function within the body.

Despite their crucial role, tendons are delicate structures. They lack abundant blood vessels, making them prone to inflammation and bursa (fluid filled sacks that stop two tissues rubbing together) interference or inflammation as well. Therefore, nurturing your tendons should form an integral part of your health and exercise maintenance regimen.

Navigating the Landscape of Tendon Injuries
Tendon injuries span a spectrum of disease states, each characterized by different degrees of pain and damage. Understanding these categories can guide you towards an appropriate treatment plan.

Tendinitis (Reactive Tendinopathy): Inflammation of the tendon, often resulting from sudden overload or repetitive stress without adequate healing time. This condition may become apparent after 4-6 weeks of unchecked activity escalation. Symptoms often diminish with activity but reappear after periods of rest.

Tendinosis (Degenerative or Dysrepair Tendinopathy): Characterized by the degradation of tendon fibers and changes in their structure. This condition emerges when repetitive stress continues without rest, and blood flow to the tendon is insufficient for healing. The body may respond by increasing blood vessel infiltration and growth (neovascularisation), leading to increased sensitivity and attempts to strengthen the tendon by depositing new tenocytes and collagen. This results in a thickened but weak and inflamed tendon. The worse the tendon gets the more it moves from dysrepair to degenerative, and the more likely you are to have unresolved or lasting pain triggers and mechanisms

Partial tendon tears: Some fibers in the tendon are damaged or torn, but the tendon remains intact. This usually occurs with sudden and uncontrolled movements in unhealthy tendons.

Full tendon tears: This involves the complete rupture of the tendon, often resulting from sudden, traumatic injuries.

Tendon avulsion: This is when the tendon detaches from the bone to which it is connected, typically due to sudden, traumatic injuries.

Understanding these different types of tendon injuries is instrumental in formulating a tailored treatment plan, enabling effective rehabilitation and ensuring the optimum use of supportive bracing.

The Healing Mechanism of Tendons
The healing process of tendons involves several stages. Initially, inflammation takes the lead, which initiates tissue clean-up, assessment, and regeneration. It's important to note that re-aggravating the injury restarts the process.

The proliferation phase follows, marked by an increase in tenocytes (healing cells of the tendon) at the injury site. Simultaneously, healing is facilitated by cells from the adjacent sheath and synovium (tendon covering) that infiltrate the damaged tendon tissue.

The final maturation stage involves the remodeling of the new tissue to better suit its function and the demands placed upon it. This phase could last for weeks to months, given that mini inflammation and proliferation stages are common for tissue stabilization.

The Protracted Healing of Tendon Injuries

One of the main reasons tendon injuries are slow to heal is their poor blood supply, depriving them of the nutrients and oxygen needed for swift recovery. Moreover, unregulated overload and repeated stress exacerbate the injury, causing chronic inflammation and triggering a persistent pain cycle.

Lifestyle factors significantly impact tendon healing. Age can slow down recovery, as the body's overall regenerative capacities decline over time. Habits like smoking impede blood flow, affecting tissue repair. Certain medical conditions, like Diabetes and Rheumatoid Arthritis, Crohn's Disease, and increased body mass or fat mass can also delay healing due to their impact on the body's immune system and overall metabolic state for optimal healing.

Most importantly though, improper care and repeated overuse and inappropriate healing measure and exercise recovery choices can exacerbate the injury, inflating the inflammation and delaying the healing phases from completing properly. These factors can push the body into a chronic state of injury, resulting in recurrent pain and protracted recovery.

The body's attempt at healing - neovascularization, or the growth of new blood vessels - can be a double-edged sword as well. While it increases nutrient and oxygen delivery, it can lead to overgrowth of blood vessels, interfering with the healing process and further adding to inflammation.

By understanding these factors, we can better treat and prevent tendon injuries, leading to improved recovery times.

Exercise Types and Bracing for Tendon Injuries

Rehabilitation exercises play a pivotal role in the healing process. They comprise isometric exercises, eccentric exercises, and plyometric exercises. Check out our blog on how to use these best. 

Isometric exercises, like planks, heel raise holds or wall sits, involve maintaining muscle tension without movement. Eccentric exercises focus on slowly lowering a weight or resisting gravity, helping build tissue resilience. Dynamic or plyometric exercises, such as jumping or hopping, are employed during the maturation phase of healing to build tolerance and create a shield against future injury.

Bracing can provide support during exercise and prevent further injury. The Sever's Sleeve and Sports Compression Sleeves can be beneficial tools, facilitating routine activities while speeding up healing.

Before starting any exercise program for tendon injuries, it's crucial to consult a healthcare professional and ensure you are put on the best evidence based recovery program for your specific injury and injury requirements. Continue browsing through our blog or reach out to our team for more guidance on your journey. We're here to help.

From Pain to Performance

The Orthopaedic Sleeve Society (TOSS)

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