A muscle usually has a tendon at each end and it is the tendon that attaches the muscle to bones. When we want to move, the muscle shortens (or lengthens) and pulls at the bones (through the tendon) and this causes the bones to move.
Picture of a myotendonous unit
Sometimes, if the myo-tendonous unit has to work too hard to pull at the bone and it becomes overloaded. This overload can be referred to (in layman terms) as tennis elbow, golfers elbow, runners knee (patella tendonitis), achilles tendonitis, repetitive stress injury (RSI), hamstring tendonitis, gluteal tendonitis, De quervain’s Syndrome, supraspinatus (shoulder) tendonitis (depending on the area of the body that is injured). These are some common areas that are overloaded but the list is endless.
This can result in;
1. Muscle tear / strain (same thing)
2. Tendon tear / strain (same thing)
3. Tendon inflammation (also called tendonitis or tendonopathy)
With any of these conditions the remedy is the same. There are 3 simple rules to follow:
1. Avoid or modify aggravating activities (don’t do anything that hurts the area)
2. Stretch the area to ‘unload’ the sore spot
3. Strengthen the area
It is vitally important that ALL 3 of these rules are adhered to. If one is left out the problem does not heal, or does not heal as fast or as well as it should.
You need to avoid or modify the aggravating activity so you don’t continue to overload the injured area. If you keep overloading, it can’t get better. It’s a bit like picking a scab and expecting the wound to heal!
Normally, it is not enough to simply avoid aggravating activities due to protecting tightness that builds. You need to stretch the affected tissue to further ‘unload’ the area. This needs to be dealt with specifically. If you remain tight in the affected area it is generally not a good healing environment. Best healing comes when the affected area is in a good healing environment…..if the injury was caused by overloading tissue, then it makes sense you need to reverse the situation by stretching to ‘unload’.
Re-strengthening is just as important as avoiding or modifying aggravating activities and stretching. When the time is right one must re-strengthen the area to reduce the likelihood of re-aggravation or re-injury. It stands to reason; if a muscle is strong it is harder to hurt.
The rules are simple but there is an art to doing the right thing, at the right time, at the right intensity and for the right duration!
This is where a good physiotherapist is worth their weight in gold. A good physio will;
Let you know:
- If you are in the right place with the right injury
- Let you know what is wrong (diagnose the injury)
- Treat the area of injury
- Refer you for imaging (if needed)
- Let you know how long it will take to get better (what is normal for this injury)
What needs to be done to get better as fast as possible
This is normally split into:
1. What the practitioner will do
2. What YOU will need to do
If you know what YOU need to do to expedite the healing process it means you can treat yourself every day and don’t need to rely on the physiotherapist for regular treatment. This is an efficient and cost effective way to manage your injury. It also, most importantly, gives you POWER over your injury. If you know what to do, at what time, at the correct intensity and duration (whether it be stretching or strengthening) then you are in control, not necessarily your injury. You can treat yourself multiple times in a day….for free!
Sometimes, myotendinous injuries do not heal as they should. Either they were too badly damaged in the first place or the balance between resting from aggravating activities, stretching and strengthening cannot be effectively achieved. In these cases, you might explore the options of different types of injections designed at speeding the healing process.
Cortisone injections are typically used on areas of inflammation (tendonitis). Cortisone can kill some pain but most importantly helps speed the processes your body naturally runs through to heal.
Blood injections (either PRP or ABI) can be used to stimulate healing in torn tendon or muscle when these areas are proving tough to heal. The process involves drawing your own blood and injecting it into the torn area. The blood is sometimes spun in a centrifuge (to split white and red blood cells) or just kept and injected as is. Both procedures, cortisone and blood injections, are typically done under ultrasound guidance (so they get the injectable fluid in the right spot) by a Doctor, Surgeon (sometimes) or the Doctor at a radiology clinic.
I hope you found this of interest and certainly if it has raised any further questions please don’t hesitate to email me at info@nepeanphysioclinic.com.au or you can book an appointment with myself or Carolyn Davies here www.nepeanphysioclinic.com.au
I will be more than happy to answer any questions,
Jono
Jonathan Harris
APA Sports & Musculoskeletal Physiotherapist
Nepean Physio Clinic
844 Nepean Hwy, Hampton E., 3188
03 9553 2078