Last newsletter we presented some basics on tendon injuries, and specifically focused on many of the fallacies therapists feed patients daily that are simply untrue.

That’s right I said it (again)……

WE ARE LYING TO OUR PATIENTS! In fact, we lie frequently during tendon injuries and it starts right from the first visit. Here are just 2 examples.

• We tell the person their tendon is ‘damaged’ and ‘inflamed’ (often untrue)
• We tell the person we can ‘fix’ their tendon in as little as 2-6 weeks (always untrue)

Today we are going to focus on this second statement. When I present on tendinopathies I focus on key messages. One article by 2 of the more renowned tendon researchers points out the most common tendon management pitfalls. Two that specifically speak to me are:

• Inaccurate beliefs and expectations about pain: Meaning ‘tears’ and ‘degeneration’ in no way cause permanent tendon weakening….and
• UNREALISTIC REHAB TIME FRAMES

The second statement was something I wanted to dig a little bit deeper on. It turns out (like most tissues in the body) tendons take a really long time to “heal” (the quotes are there because sometimes your tendon may never fully heal but become just as strong and functional as before).

In the past 12 months, there has been VERY compelling research that a major part of the tendon healing process is centrally guided, literally meaning it is governed by the brain and not locally just at the tendon. There are lots of cool studies proving this that are beyond the scope of this blog (search tendon neuroplastic training and the author Rio if this is of particular interest to you). In one cool study, a surgeon in Sweden saw people with Achilles tendinopathy on both sides using a new surgical technique however he only treated one side. As you can probably guess…..both sides resolved despite one side not even having the surgery.

It actually turns out that most pain reduction in tendon injury at the beginning of your recovery is due to central changes (meaning your central nervous system). So you may FEEL better, but you likely ARE NOT actually better. And yet, most rehab professionals will tell you they can ‘fix’ your tendon injury in a few weeks timeframe.

So how long does this process actually take? Prepare to be discouraged……6 months or more.

In fact, some leading researchers on tendon injury put out this beautiful graph below in the September issue of the British Journal of Sports Medicine nicely outlining what happens in the recovery of tendon injuries.

So essentially the first number of weeks, when you feel better, it is a central nervous system change improving your pain.

After that, it is a change in the muscle that the tendon arises from. The muscle gets stronger, functions better, and there is less pain in the tendon (assuming appropriate rehab).

Lastly, at the 6 month mark, you may have an improvement in the tendon.

So that sucks.

And yet it mimics most body systems. It is generally accepted when you start to strength train, you get strong (at times very strong) in the first 8-12 weeks. Yet, there is no increase in actual muscle size. Essentially your nervous system (specifically the nerves to your muscles) have become more efficient and are able to recruit more muscle fibres and you get stronger. Now if you stick with your program, around the 2-3 month mark you will start seeing actual muscle growth.

Why does your therapist have no problem telling you that it may take 3 months for your stress fracture to heal? Or it may take even longer for a ligament tear to heal? But with tendon injuries they have no issue telling you that they can ‘fix it’ in a few weeks. In truth, you may actually feel better in that timeframe…..but now we know it is likely a central nervous system change and the tendon itself is not changing. As a patient, this sets you up for repeat occurrences of tendon injury if you stop rehabbing at this point. And by rehabbing we mean applying the appropriate amount of loading to the tendon through exercises guided by your rehabber.

Rehabilitation is a free market economy. You are the consumer. Demand better! As a therapist it sucks when you get a patient struggling with a tendon injury for months and are upset because a prior therapist told them they will be better in a couple of weeks and can return to their sport full bore. Keeping people active and applying load to the injured tendon is the name of the game, however we have to re-examine what we are saying to our patients and perhaps a new model of tendon healing needs to be adopted.

Vent over!