Have you been dealing with a dull ache that doesn’t seem to go away, or maybe you were out being active and suddenly felt an intense pain and tearing sensation? Whatever level of pain you might be dealing with, it is essential to get expert advice. Knowing the causes, symptoms, and treatment options for the most common tendon injuries will help you get back to feeling your best in no time.
Whether you’re an athlete, manual labourer, or weekend warrior, let’s take a look at everything that you need to know about staying well. Recognising the early signs of an overuse injury to understanding your treatment choices to avoid injury, here is your complete guide to common tendon injuries.
What Is a Tendon?
Your tendons are more important than you might realise. These fibrous cords that connect your muscles to bones transmit the force that allows you to move your joints. That’s why dealing with a tendon injury has such a major impact on every aspect of your life. But, what exactly is a tendon?
Your tendon is a tough, flexible band of fibrous connective tissue that anchors your muscles to your bones. Each one of your tendons is made up of collagen, a rigid kind of protein that is connected in strands that run parallel to the natural direction of force in your body. When you use your muscle, it pulls on your tendon. This movement of your tendon transfers force to your bone and causes your joint to move. These internal transfers of power all happen in a fraction of a second.
While we rarely think about them, our tendons are actually a remarkable body part that can withstand high levels of force while staying flexible and agile. They work like strong and flexible cables connecting your muscles to your skeletal system. Without healthy tendons, it would be impossible to walk, run, jump or lift anything. These connective tissues are vital for posture and movement.
Where Are Tendons Located?
There are tendons throughout your body that attach your muscles to your bones. When you have a sense of where each one is located, it is easier to pinpoint the exact source of your pain. Here are some of the major tendon locations:
- Achilles tendon attaches your calf muscles to the heel bone
- patellar tendon connects your kneecap to the shinbone
- Quadriceps tendon connects your thigh muscles to the kneecap
- Hamstring tendons attach the back of your thigh to your lower leg
- Rotator cuff tendons connect your shoulder muscles to your upper arm
- Biceps tendon attaches your biceps muscle to your shoulder and elbow
- Triceps tendon connects your triceps muscle to your elbow
- Forearm extensor tendons attach the muscles to the back of your hand
- Forearm flexor tendons attach the muscles to the palm side of your hand
- Finger flexor tendons allow you to bend your finger joints
- Abductor pollicis longus tendon bends your thumb
- Extensor pollicis longus tendon straightens your thumb
- Peroneal tendons stabilise your outer ankle and foot
- Tibialis posterior tendon supports the arch on your inner ankle
- Adductor tendons attach your inner thigh muscles to the bone
- IT band connects your outer hip muscles to your knee
- Popliteus tendon unlocks your knee joint
While your tendons are located throughout your body, exercise tends to put the heaviest load onto the tendons of your feet, ankles, knees, hips, shoulders, elbows, and hands. Overuse and high stress on the tendons in these areas mean that they are the most frequently injured.
What Causes a Tendon Injury?
Tendon injuries can happen suddenly or they can appear gradually over time. There are a wide range of different factors that can cause irritated, inflamed, and even ruptured tendons. Understanding the root cause of your tendon pain is essential to creating a proper treatment plan as well as preventing future injuries.
From joint overuse to anatomical issues, there is no single cause, but some common causes are behind most tendon damage cases. Knowing these key causes will help you prevent injuries and avoid making an existing issue worse.
When you are able to recognise the signs of tendon irritation early on, you can address them as soon as possible. This will get you on the road to recovery faster and prevent the injury from getting worse.
Here are some of the most common causes of injuries:
- Overuse: Repeated microtears from excessive use of a tendon cause tendinitis or tendinosis. Sports like running, deadlifting, tennis, and golf involve repetitive motions that can irritate tendons over time.
- Overly intense workouts such as HIIT and F45: Sudden increases in your training duration or intensity can overwhelm your tendon, which can cause tears or ruptures.
- Direct trauma: Tendons can be cut by sharp objects, jammed by blunt force, or compressed against your bone.
- Muscle imbalance: Imbalances between muscle groups put stress on certain tendons more than others during movement (e.g. weak glutes or core can strain your knee tendons).
- Inflexibility: Tight muscles and joints put a strain on your tendons, which can lead to microtears (e.g. limited ankle mobility stresses the Achilles tendon).
- Poor form: Using improper techniques like over-striding when running can cause inflamed and irritated tendons.
- Insufficient recovery: Not getting enough rest between training sessions means that your tendons lack the time for proper tendon tissue repair and remodelling.
- Biological factors: Systemic diseases like diabetes, rheumatoid arthritis, and ageing affect your tendon structure and make them more prone to injury.
- Medications: Certain antibiotics can interfere with the metabolism in your tendon and increase the risk of rupture.
- Environmental factors: Cold weather and improper footwear can heighten injury risk.
Risk Factors for a Tendon Injury
On top of certain behaviour that makes injuries to your tendons more likely, there are certain things that make you more likely to be injured.
Here are some of the major risk factors that can predispose someone to a tendon injury:
- Age: Tendons lose strength and elasticity as you get older and this increases your risk of tears and ruptures.
- Prior injury: Previous damage to your tendon can weaken it and make it more prone to re-injury.
- Overuse: Repetitive strain from certain sports, jobs, and everyday activities can irritate your tendons over time.
- Medical conditions – Diabetes, arthritis, hyperparathyroidism, and autoimmune diseases make tendon damage more likely.
- Nutrition: Diets lacking in protein and vitamin C can affect your tendon health.
- Genetics: Variations in collagen production can cause a predisposition to tendon abnormalities.
Being aware of these risk factors can help you to make the necessary changes to your training, technique, equipment, environment, and lifestyle to help avoid tendon injury.
How Do I Know If I Have a Torn Tendon?
If you are wondering what is causing your pain, there are certain symptoms of a tendon injury that you should look out for. Here are some of the common signs and symptoms of tendon injuries:
- Pain during or after activity around a particular joint
- Stiffness in the mornings
- Stiffness during periods of rest
- Visible swelling or thickening
- A feeling of heat around the affected tendon
- Weakness in the joint
- Limited range of motion
- A lump near the joint
While there are certain common symptoms of a tear in the tendon, it is impossible to diagnose just by guessing. If you are dealing with pain and have not seen a doctor yet, it is essential to get it checked out. Ignoring an injury not only delays you from feeling better but that lack of treatment can turn a minor injury into a serious one.
Treating a Torn Tendon
A torn or ruptured tendon can be extremely painful and completely stop you in your tracks. Whether it is a partial or complete tear, proper treatment is crucial to regaining your joint function and getting started with proper healing. There are both conservative (non-surgical) treatment options focused on natural healing. For more severe cases, there are also surgical options that will allow a surgeon to reattach and repair your torn tendons.
The best treatment for your torn or injured tendon depends on different factors like the severity of the tear, its location, your health background, and your general activity level. In all cases, the first steps are always non-surgical. Lifestyle adjustments and non-invasive measures can typically treat minor to moderate injuries. Here are a few common treatments for an injury to a tendon.
Most tendon injuries are initially treated non-surgically with the following:
- Rest: avoiding activities that aggravate the injury
- Ice: Reduces pain and swelling
- Compression: Supports and immobilises
- Elevation: Decreases swelling
- NSAIDs: Reduce inflammation and pain
- Braces: Provides stability and offloads tendon
- Physical therapy: Stretching and building muscles
- Exercises: Boosting strength in the surrounding muscles
- Corticosteroids: Injections relieve acute inflammation
Understanding the available treatments for torn tendons will help guide discussions with your doctor to determine the ideal management plan. With appropriate care, most torn tendons can be effectively treated to resolve pain and restore mobility and strength.
Do I Need Surgery for a Tendon Injury?
When non-invasive treatment isn’t enough to resolve the issue, your doctor may recommend surgery to repair the damage and restore normal function. The operation can be performed either arthroscopically through several small incisions or as open surgery with one larger incision exposing the full tendon. During the operation, your surgeon will determine the location of the tear and remove any frayed or degenerated tendon tissue. The ends of the tendon will be reconnected if needed. To securely reattach the tendon, sutures or bone anchors will be used to fix it back to the bone.
After surgery, your joint will be immobilised in a splint or cast for two to six weeks. After about a month, you will get started with physical therapy to gradually restore your flexibility, strength, and motion.
Healing Time After Surgery for a Tendon Injury
While each person will have a different experience, there are some general timelines for healing after tendon surgery.
- Minor tendon repair: For a small tear or laceration, you can expect immobilisation with a splint or cast for four to six weeks. After that, you can gradually return to activity over several weeks. The full recovery time typically takes three to four months.
- Major tendon repair: For a large tear or rupture, you will need immobilisation for six to eight weeks. This will be followed by gradual physical therapy to improve your strength and range of motion over the course of several months. Full recovery can take 6 months to one year.
- Tendon transfer or reconstruction: In this case, you can expect immobilisation for six to eight weeks, followed up by up to a year of physical therapy.
- Tendon release or lengthening: Your doctor will recommend Immobilization for two to four weeks, then gentle stretching and strengthening. You can typically return to normal activity in six to 12 weeks.
It is essential to keep in mind that the exact timeline will depend on the location and severity of your tendon injury, as well as the surgical approach. Your age and overall health will have a major impact too so it is important to not rush your recovery. Your treatment plan must be slow and steady to allow your tendon to fully heal before stressing it. Trying to rush back too soon increases your risk of reinjury or complications.
Preventing Injuries to Your Tendons
Avoiding injuries is crucial, and that is doubly true if you have already injured one of your tendons. Keep in mind that injury is more likely if you’ve already had an injury.
Here is how to avoid tendon injuries:
- Warm up and stretch properly. This can also prevent muscles from cramping
- Slowly increase workout difficulty over time
- Focus on strength training
- Always prioritise proper techniques during physical activities
- Wear appropriate footwear and safety gear which can also prevent foot pain
- Schedule rest days after intense sessions. It is also important to stay under shades whenever possible when out to prevent heat injuries.
- Follow a prescribed treatment plan for any muscle imbalances or inflexibility
- See a doctor to address any underlying medical conditions
Staying Healthy: Bottom Line
Tendon injuries are common in active people. While they can be difficult to avoid, they respond very well to quick and comprehensive treatment. A combination of rest, reducing inflammation and improving your flexibility and strength will help you heal. Surgical repair may be needed in more severe or long-standing cases but the results make it well worth it. With proper rehabilitation, most tendon problems can successfully be resolved with a complete recovery. The key to success to being aware of signs of overuse, adjusting your training as needed, and utilising preventive strategies to help keep tendons healthy and resilient.
Getting Help for Tendon Injuries in Singapore
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About the Author
Dr James Tan is a highly skilled orthopaedic surgeon who has more than 10 years of experience in sports surgery and exercise medicine. He is a member of the elite Asian Shoulder and Elbow Group and a founding member of the Singapore Shoulder and Elbow Surgery Society.
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