We explain the various causes of tendon injuries

Albert Giménez

19 in March, 2014

The term tendinitis is a word that has been used indiscriminately and abusively to designate most of the disorders that occur in the tendon and in which phenomena associated with inflammation are frequently observed.

The tendons are anatomical structures located between the muscle and the bone. Its function is to transmit the force generated from the first to the second and thus allow the joint movement.
The tendons have in all their length three specific zones:
1. The point of union between the muscle and the tendon or myotendinous union
2. The union between the tendon and bone or osteotendinous union
3. The middle zone or body of the tendon
The composition of the tendons is collagen in 30%, elastin in 2% and water in 68%. The tendons are structures with very little vascularization, in fact until the beginning of the 20th century the tendon was considered an avascular and metabolically inactive element, and it was not until 1916 that its vascular contribution was demonstrated. It was from the 1965, thanks to the work of Smith, which attributes to the tendon a metabolic activity caused by its continuous flow of blood.
Despite this discovery, we know that your blood supply is precarious, which only increases during exercise and before healing processes. On the other hand, it is diminished when the tendon is subjected to tension or in certain areas of friction, torsion or compression, so that we find very little irrigated areas (usually in the middle area of ​​the tendon) and which are known as critical zone The irrigation of the tendons is more deficient in the men than in the women and is falling progressively with the age and mainly with the mechanical overload.
All this causes, in the face of a traumatic aggression, the tendons heal very slowly. Innervation is sensitive and abundant and plays an indispensable role in the regulation of muscle contraction.
Why are the tendons injured?
The tendons are injured by two causes:
1. For external or extrinsic problems. In the tendon injuries of external or extrinsic cause, it is very important if you want not only a temporary improvement but a definitive improvement to identify the lesion cause and correct it. If this is not the case, symptomatology, although it may disappear initially, will subsequently reappear.
2. For internal or intrinsic problems. As main extrinsic or mechanical causes we have:
Above-all: excess traction produces injuries with inflammation, edema and pain. If the injury progresses Tendinosis may appear, that is, degeneration that can cause partial splitting and breakage.
Fatigue or muscle weakness: muscle is unable to lengthen to protect the tendon from the injury.
Alteration of muscle balance: especially in the sports world, the imbalances between agonist and antagonistic muscles are very frequent when we do very repetitive sport gestures and taken to the limit, since in some cases they exceed the mechanical and physiological limits tolerated by the muscles.
In modern sports training, the importance of the role of eccentric loading in the future and the treatment of tendinopathy has been demonstrated. The eccentric work training allows an increase in the voltage to which the musculotendinous unit can be subjected during its extension, which implies a better tolerance to the eccentric applications at the level of the tendons at the reception of jumps or on the shot preparation If the tendon has not been prepared, these applications may result in shear forces, tendons and tendon injuries that originate in joint dysfunction.
So, with regard to eccentric work, tendiness elasticity is one of the necessary parameters along with another called «critical force». This is the application of a muscular force on the tendon that can cause stress, the pattern of which determines the areas where most injuries are lodged.
As intrinsic or metabolic causes we have:
Tended aging: it is associated with inflammation and repetitive microtraumatisms. There is also a subsequent degradation, difficulty in healing and repairing the tissue.
Metabolic insufflation: With enough rest time after stress, the tendon can be recovered, but a new request before its recovery process has been completed can lead to a permanent injury that will lead to tendonitis (degeneration of the tendon).
Acute tendon injuries can be produced for many reasons, but in any case they are characterized to know the exact moment in which the injury occurs. With the right treatment, the repair process and the final result are predictable in terms of time and compliance with the objectives set in the rehabilitation.
In any case, the chronification of the lesions is a very frequent result in those of a tendon type. There is usually a long evolution, even years, in which there are alternating stages of reagenting the problem with others in which it may not give symptoms.
The most characteristic element of acute injuries is inflammation, whereas in the chronic injury or tendinitis it is the tissue degeneration. This tends to evolve to suffer from total or partial lesions in the tendon when repeatedly requested or overloaded abruptly.
What depends on the failure of the repair process in tendon injuries?
Factors that can fail can be intrinsic and depend on the patient or extrinsic factors to him.
Intrinsic factors
Age: especially increases the risk with age, and it seems that the risk is lower between 15 and 35 years.
Vascular insufficiency: in the peripheral venous insufficiency of the lower extremity, in diabetes or hypertension, since these situations share a common denominator: the diminution of the blood regrowth of the tissues. Hypercholesterolemia, hyperparathyroidism, chronic kidney failure and gout are also found in this group.
Persistence of the symptoms: the presence of pain for more than six months is a bad augury.
Persistence of functional deficits: such as elasticity, strength, resistance or amplitude of the limited movement, among others. Also, pictures that tend to have tendonoligmental hyperlaxis and which preferably affect the joints, tendinitis are the result of the deficit.
Extrinsic factors
Overly repetitive: it is essential to maintain the balance between activity and rest.
Administration of certain medications: such as glucocorticoids, chemotherapies or being the patient subjected to radiation due to another problem.
Deficient or insufficient treatment.
Environmental factors: such as heat, intense cold, moisture or even altitude may influence the possibility of tendon injuries.
The tendons require that their repair time be respected, but above all in the sports field. Through exercise, the tendon is able to adapt to large loads. For this, hyperthyroidism or change its mechanical properties to increase its strength by section, as evidenced by several scientific works.
For all this, an accurate diagnosis is required to help us avoid the motive of tendon injury and establish a treatment and rehabilitation program for the training. Each injury requires individual attention and establish appropriate physiotherapeutic treatment through cold, rest, electrotherapy, ultrasound, laser, massage ... and also apply initially mild stretches, followed by stronger stretching and active exercise.

the author

Albert Giménez

Sports physician and osteopath of the Claror Sardenya

Degree in Medicine (UAB). Osteopath

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