Tendon healing

	1. Normal tendon structure (parallel collagen fibres attached to the bone)
	2. Tendinopathy. Due to damage, some of the normal collagen fibres have been replaced by scar tissue, which has similar structure but is not as strong.
	3. Tendonitis. Secondary to the damage within the tendon substance, inflammatory changes have developed around the tendon. Anti-inflammatory medication (including tablets and cortisone injections) can help relieve pain, but do not help heal the tendon damage.
	4. Healing tendon. The scar tissue within the tendon is starting to re-organise and can some structural strength. The best way to make this happen is to repeatedly load the tendon below its threshold of damage. Overload is dangerous, but complete rest means that the healing won't occur either.
	5. The goal of any tendinopathy is a healed tendon, where new collagen fibres have grown and the tendon is now as strong as the original and is no longer painful. The tendon is usually a little wider and less elastic, but highly functional. In the vast majority of tendinopathy cases, healing like this is possible.
	6. One of the reasons for chronic unrelenting tendon pain is when the tendon has partially torn from the bone, with the remaining tendon pulling excessively on the bone. Sometimes tendon strengthening may solve this problem, but other times surgery can be needed. In cases where the tendon has many other tendons nearby to heal down to, a procedure such as a tenotomy (release of the remaining tendon from the bone) can be used. Where the tendon is more isolated, an augmentation or repair must be used, which takes much longer to recover from.
	7. A tendon rupture is a complete breakdown in continuity of the fibres. In certain tendons that act alone (such as the Achilles tendon), this outcome can be a disaster for function, unless the tendon is surgically repaired. With tendons that have many other tendons nearby to assist with function, a complete rupture is often far less painful than a chronic partial tear, and may even sometimes be a desired outcome.
	8. Tendon healed post-surgery. When a complete or partial tendon tear is surgically repaired, the outcome is eventually (after months) a very thick but strong tendon. Elasticity is lost, so the speed of muscle function may be slightly diminished, but the tendon is usually strong and pain-free.

Links in this site :

Achilles injuries and Eccentric Achilles strengthening

Adductor tendinopathy

Finger tendon ruptures

Patellar tendon injuries and Quads eccentric exercises

Rotator cuff injuries

Tennis elbow and tennis elbow exercises

What is tendonitis (tendinopathy)?

Tendonitis means, literally, “inflammation of a tendon” and this is probably a bad name for the condition. Inflammation of the tendons can occur, but the most common tendon disorders involve degeneration of the tendon due to an inability to cope with the load that the tendon is placed under.

What determines the amount of load that tendons can handle and whether this is exceeded?

The human body is designed so that the size of tendons is just greater than the maximum force they are likely to need to endure. There is a good reason why they aren't made a lot bigger than this. When a tendon is under close to its maximum force, it stretches slightly (without being damaged) and can store energy to recoil elastically a short time later. This mechanism of energy storage in tendons allows humans (and other animals) to run, jump and throw faster than would be possible if tendons were built to be much wider than they actually are. The disadvantage of having only a small amount of leeway in the size of most tendons is that if tendons develop some partial damage (degeneration) they can start to fail under normal circumstances (when they should only be stretching, not failing).

Can damaged tendons heal?

The good news is that tendons have a good ability to heal in adults. Tendons are mainly made up of fibres of a substance called collagen. The body heals most areas of damage with scar tissue, which is also made up of collagen. The only major difference between undamaged tendon and scar tissue, is that in normal tendon the collagen fibres are all arranged neatly in a vertical alignment to best withstand the force that the tendon will be placed under, whereas in scar tissue the collagen fibres are randomly arranged in many directions. This means that for the same width of tissue, normal tendon can withstand a much greater vertical pulling force than scar tissue.

What is the best way to treat tendonitis?

(1) Reduce the load on the tendon BELOW the threshold of further damage?

(2) Exercise the tendon to strength it below this threshold, rather than totally rest.

(3) Consider other factors which may improve the rate of tendon healing (e.g. Aprotinin injections ).

To post a comment or ask a question about these injuries, visit the cricketinjuries Forum, click here .