In our last 2 posts we discussed what causes tendonitis, and how to fix it if we do have tendonitis.  If you missed it, check those posts out here. 

Part I – Causes of Tendonitis

Part II – How to Fix Tendonitis

That leaves only one unanswered question, how can we decrease our chances of getting tendonitis in the first place? 

This question is a little trickier.  The reason why we get tendonopathies is still somewhat unknown.  This is what we do know though: 

1. Tendonopathies can be caused by a variety of different risk factors.  The main factor that we can control is overuse.  This is particularly true in movements that require the tendon to store energy such as walking, jumping or running, and movements that compress the tendon such as aggressive stretching or performing an activity that compresses the tendon against a bone.   
2. When the tendon is loaded gradually and progressively it allows the tendon to develop a greater tolerance to the loads that you need to endure. 
3. Biomechanics matter. 

So how can we use knowledge to help prevent the development of a tendinopathy? 

   Well, let’s say for a minute that you have decided to run a 5k but you have never really run very much.  Knowing that tendinopathies usually develop from activities that require the tendon to store energy like running, jogging and even walking you might want to exercise extra care when you begin.  Does this mean that you shouldn’t run a 5k?  No, not at all, it is a great thing to do for general health, and for your cardiorespiratory fitness.  Thankfully, you know that the tendon does better with gradual and progressive loading, so don’t try to go and run a full 5k right away.  Start slowly, and gradually work your way with distance and speed.  This will allow the tendon to develop a greater tolerance to the load that you will need it to endure when you are running. 

But I don’t like running!….

There are other ways to prepare the tendon as well.  For instance, resistance training.  Resistance training has been shown to increase tendon stiffness.  Although we usually associate stiffness with poor movement, in this sense it is a good thing.  Think of a new stiff spring versus an old stretched out one. The stiff spring works much better and so does a stiff tendon.  Resistance training has also been shown to improve the tensile strength of a tendon, so it will have the ability to withstand greater forces before rupturing. 

Biomechanics Matter

This is also where biomechanics matter.  Running and resistance training are both beneficial for the tendon, especially when programmed and progressed appropriately.  However, if you are performing exercise with poor biomechanics (poor form), you may be compressing the tendon, and, instead of building up the tendon, you are breaking it down.  So how can you make sure you are doing the exercises correctly?  Well, this is where a physical therapist or movement professional might be useful.  Since we are using the example of running, we will continue with that.  A PT or medical professional may be able to conduct a running analysis to examine where your foot is striking, how your ankle and foot move when weight it put through them, and how the hip, knees and ankles work together.  By modifying these factors, you will be able to achieve a stride that will help build up the tendon, improve tendon stiffness, and tensile load allowing you to perform better, and maintain good health. 

Although we used the example of running because it is an easy one, the same is true with an overuse injury such last tennis elbow, or golfer’s elbow.  Let’s take the same 3 things that we know about tendons and apply it to these type of overuse injuries.  For this one we are going to start backwards on the list.  First, biomechanics matter.  When we think about overuse injuries, this is probably the number one thing you can do to prevent them.  The first thing you will want to look at is your ergonomic setup.  If your desk setup causes an abnormal position of your hand or wrist, it can cause a compressive force for prolonged periods of time on the tendon.  This will lead to degradation of the tendon and eventual injury.  If you are unsure if your workstation is set up the way it should be, check with your employer about getting an ergonomic assessment, it will likely pay off in the long run. 

Preparing to Work

Knowing that the tendon responds better to a gradual and progressive load will also help guide you with overuse injuries.  If you are starting a new job that requires you to perform repetitive motion, it is best to ease into your responsibilities if that is possible.  This will help allow the tendon a chance to adapt in between bouts of stress and will allow healing to occur.  During this time proper body mechanics will be of huge importance to make sure that excessive stress is not put on the tendon.  Also, because tendons can be built up through gradual, progressive loading you know that you can prepare your tendons for activity before you even start a job!  We have found that many self-insured companies have started doing this with great success.  During the initial training phase their employees are required to participate in a “work hardening program”. This involves strengthening exercises specifically targeted toward the demands of their job.  Some of these programs may include exercises for the hands, wrists, elbows and shoulders, those joints more prone to overuse injuries.  They have found that the incidence of repetitive stress injuries decreased enough to make it worth paying their employees to participate in these programs.  Having a physical therapist who is aware of your job demands can be beneficial.  They can help design and supervise the program to make sure that the correct exercises are being performed and that those exercises are being performed correctly. 

Adaptation and Nutrition

There is one other key concept that needs to be taken into consideration when trying to reduce the chances of having a tendinopathy.  Most of the treatments as well as methods to prevent tendon dysfunction is based on the theory of adaptation.  The body adapts to the demands that you put on it.  That is why exercise causes the tendon to get stiffer and stronger; the body adapts to meet the demands you put on it.  The body, though, can only adapt if it is provided with the proper environment for that to take place.  So how do you create the correct environment?  By ensuring proper balance of nutrition, hydration, sleep and activity.  Although these factors are highly individual there are some general principles that we can keep in mind.  Eating a well balanced diet with the proper amount of calories ensures that you have the nutrients required to maintain and build healthy tissues.  If you are eating too few calories, your body may not have the energy required to create new tissues and complete its metabolic processes. Too many calories can lead to obesity, which has been associated with chronic low grade inflammation.  Eating a variety of food and having a well balanced diet will help to ensure there are no nutrient deficiencies and provide you with all the micronutrients that help keep your body running just the way that it should.  The same is true of proper hydration.  If you don’t provide the body with the needed water, it can’t possibly be expected to heal, and operate optimally.  A third factor is sleep.  Sleep is also vital for proper adaptions to occur.  In multiple studies, sleep deprivation has been associated with increased pain levels and negative metabolic changes that affect the body’s ability to adapt to stress.  

Although there is no guarantee that these steps will prevent you from ever getting a tendinopathy, the basic steps with help to ensure you significantly decrease your chances.