Tendon Healing and Exercise Guidelines for Recovery
Tendons play a crucial role in connecting muscles to bones, enabling movement and providing stability to our bodies. Unfortunately, tendon injuries are not uncommon and can significantly impact our daily lives. Some of the most common running injuries that I see in the clinic involve tendons, including achilles tendon, patellar tendon, and tibialis posterior or peroneal tendons. If you've experienced a tendon injury or are looking to prevent one, understanding the healing process and incorporating targeted exercises can greatly aid in your recovery. It is important to manage appropriate load in order to facilitate healing. Oftentimes athletes will do too much too soon which can potentially set them back in their healing process and trap them in a recurrent chronic injury cycle. This article provides a breakdown of the timeframe for tendon healing and suggests some of the basic exercise guidelines to help regain strength, stability, and flexibility.
The Timeframe for Tendon Healing
Tendon healing is a complex and gradual process that varies depending on the type and severity of the injury. Having some awareness of the basic physiologic processes as well as the timeframe can help you to better understand how to approach rehab and plan accordingly. While every individual's healing journey is unique, there are three broad stages of tendon healing:
Inflammatory Stage: This initial stage lasts for approximately 1 to 7 days following an injury. Inflammation occurs as the body's natural response to tissue damage. During this phase, it is crucial to protect the injured tendon, manage pain and swelling, and allow the body to initiate the healing process.
Repair Stage: The repair stage typically extends from 1 to 6 weeks after the injury. In this phase, the body begins to create new collagen fibers to bridge the gap in the damaged tendon. Physical therapy and targeted exercises often commence during this stage to promote proper healing and prevent excessive scar tissue formation.
Remodeling Stage: The remodeling stage can last from several weeks to months or even years. During this phase, the newly formed collagen fibers gradually align along the lines of stress and mature, enhancing the strength and functionality of the healing tendon. It is essential to continue exercises and rehabilitation protocols to optimize tendon remodeling and prevent re-injury.
Exercise Guidelines for Tendon Recovery
It is important to note that the exercises recommended for tendon recovery may vary depending on the specific tendon affected and the guidance provided by healthcare professionals. Here are some commonly prescribed exercises that can aid in tendon healing:
Range of Motion (ROM) Exercises: These exercises help maintain joint and soft tissue mobility and prevent stiffness. Gentle stretching and controlled movements of the affected joint should be performed within a pain-free range. (Ideally performed during the initial stages of rehabilitation, i.e. inflammatory and repair stages, to patient tolerance).
Soft Tissue Mobilization: This type of intervention is often provided by a physical therapist but it is possible to do on your own at home. Making sure that you maintain pliability in the surrounding soft tissues will help to reduce local stress on the tendon. Working “above and below the affected area” can help to promote increased blood flow, reduce fascial restrictions, and allow for better mobility through the entire area. (Same as above, ideally performed during initial stages of healing).
Eccentric Exercises: Eccentric exercises involve lengthening the tendon while it is under tension. They are particularly effective in promoting tendon healing and strengthening. An example is the heel drop exercise for achilles tendon injuries, where you slowly lower your heel off a step or curb. These are very common exercises in physical therapy and should be applied during the appropriate stage of healing. (Ideally performed during repair and remodeling stages).
Isometric Exercises: Isometric exercises involve contracting the muscle without changing its length. They help to activate the muscles surrounding the injured tendon without placing excessive strain on the healing tissue. Isometric exercises can be done by pushing against a stable surface or using resistance bands. (Isometrics can be initiated in the repair stage of healing, if not sooner, per patient tolerance).
Gradual Strengthening Exercises: As the healing progresses, gradual strengthening exercises can be introduced. These exercises involve controlled resistance training to improve muscle strength, which in turn supports the healing tendon. It is crucial to start with light loads and gradually increase resistance over time. Another aspect that should be included in later stages of training are more dynamic and plyometric types of exercises, especially if returning to a sport such as running. In order to improve tissue elasticity and recoil, you must train it after an injury. Athletes should start out with light load, short duration double limb loading and gradually work up to single limb, deeper range, higher intensity loading.
Proprioception and Balance Exercises: These exercises focus on improving balance and coordination, which are essential for functional recovery and injury prevention. You can use different variables such as static versus dynamic, even versus uneven surfaces, with or without resistance applied, etc. Performing these types of drills with or without shoes will also help to develop these systems. Make sure that the types of exercises are targeted and appropriate for the sport that you are returning to. (Can be performed in the repair and remodeling stages).
Tendon injuries require time, patience, and a comprehensive approach to ensure proper healing. Understanding the timeframe for tendon healing and incorporating targeted exercises as part of a rehabilitation program can significantly aid in the recovery process. Remember to consult with a qualified healthcare professional or physical therapist who can provide specific guidance tailored to your injury.
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