On Tendons

Tendon and ligament health is a popular topic of discussion in rehabilitation circles, and for good reason. A number of injuries involve these tissues, and particularly in professional sports it seems to be more prominent each year. These structures are vital in our ability to move efficiently and when injured can take months to recover. The elastic nature of tendons is often ignored in our discussions on recuperating, with discussions focusing on regaining strength as a proxy measure for return to sport or daily activities.

Tendons connect muscles to bone, allowing muscles to propagate force along their attachment points. They are elastic in nature, meaning they store and release energy very effectively. Tendons allow us to be much more efficient than we would be by only moving around via our muscles. Muscles do a tremendous job squeezing and stopping bones from moving, providing tendons the opportunity to propel us forward or slow us down.

The ongoing trend in rehabilitation is to regain muscle strength, or force production, after an injury. There is ample evidence that increasing a muscles ability to generate force has some sort of protective effect on tissues. We may be neglecting tendon pliability and other connective tissues. This could be a part of what is limiting us from progressing in our effectiveness for patients. Resistance exercise reliably develops muscle mass when prescribed appropriately, however that increased mass most likely alters how tendons function due to their deep investment within each other. If muscles squeeze, and put tension on tendons, the ability for said tendon to store energy has immediately been reduced. Any activity where elongating that particular tendon is required, it is starting from a deficit due to the increased activity of its muscular counterpart. The right circumstance may now lend itself to that tendon lengthening beyond its capacity and tearing to some degree.

Resistance training is a useful aspect of rehabilitation, however activities like hopping, jumping, bounding and landing may be more useful in regaining tendon health. These types of activities, where energy is quickly converted from potential to kinetic energy, may not only provide the necessary skills to move more efficiently, but also regain the tissue quality needed to produce it.

Tendon injuries often require extensive rehabilitation and a notable amount of time to recover from. This tissue type is a key aspect of efficient movement, storing and releasing energy that is paramount in all aspects of propulsion. Our rehabilitation models may not be adequately considering the behaviors of tendons and how they contribute to our movement capabilities. If we can rehabilitate our patients with the intention of adapting the elastic mechanisms properly, we may find ourselves with fewer injuries to contend with.

Austin Ulrich, Physical Therapist