Tendonitis or Tendinosis Running Injuries

Runners commonly experience muscle and tendon injuries following several weeks or months of logging running. Many will say they didn't do anything new. They were not running harder, faster, more hills, or different surfaces. Yet, they developed pain that started as stiffness and progressed into an injury.

Think of how many steps you have taken this year. With each pounding step, gravity places stress onto our joints. Something needs to absorb this force and it is spread between shoes, muscles, tendons, and joints. Over time, the amount of pounding can overwhelm one of these regions. Think what would happen if your shoes are old and worn; they will absorb less force and the muscles, tendons, and joints will have to absorb that force. What happens to your body when you get tired and your running gait changes? Do you become less smooth and efficient, often running heavier and pounding? Can you hear how loud your foot strike is at the end of a run compared to the middle? Do you have friends who are smooth and efficient runners and friends who pound the pavement with every step? Who is more likely to be injured? This excessive stress with pounding can injure muscles, ligaments or tendons; causing inflammation, swelling and pain.

Tendons are like Ropes

Think of a tendon like a rope that is tied to a tree. Each tug on the rope places tension and stress on the rope, especially where the rope is tied to the tree. Since this area absorbs the most focused stress, it is the most likely area of rope to become damaged and fray. With enough pulling and fraying the rope becomes severely damaged.

Repeated stress "frays" tendons and ligaments in a similar manner. In the body "fraying tendons" produce an injury we call tendinosis or tendonitis (tendinosis is the correct medical term, but tendonitis is often used in everyday language). Tendinosis is damage to the tendon that requires healing and repair of the "frayed fibers." The body will fix the injured fibers and lay down extra fibers to strengthen the rope. The end result will be a stronger tendon.

However some people try and run through the injury, creating more damage. Sometimes trying to run through an injury creates a situation where the body generates scar tissue rather than healing, which leads to chronic injuries. (Read more about Scar Tissue and Scar Tissue Treatment.

IT Band Running Injuries

Tendon injuries are a mechanical problem which requires treatment to decrease stress and promote healing. Multiple therapies are available to encourage healing; the most important part of therapy is removing the problems that lead to the injury. For example, IT band tendinosis is often caused by a tight muscle pulling on the IT band causing it to rub wrong on the knee. In addition, certain hip or foot muscle weakness increases the stress on the IT Band, thereby increasing the likelihood of knee pain.

Getting rid of the tendon pain and getting the tendon to heal is just part of the solution. The weak muscles need to be strengthened, and tight muscles need to be stretched and relaxed. Running mileage should be increased at a rate that does not aggravate the IT band but also gets you back to your previous activity level as fast as possible.

Trying to increase the mileage too quickly will most likely produce another injury. Just ask a runner who has had the same injury for several years in a row after he thinks it has gone away. It is very probable he just waited for it to stop hurting and then ran on his own schedule; he probably didn't address the muscle weakness or work on decreasing muscle spasms. If most of his treatment protocol relied on foam rollers, ask someone else for advice. Foam rollers help, but they only reduce some of the spasms. They certainly do not increase muscle strength or reduce muscle imbalances.

Chronic Running Tendon Injuries

People with chronic IT band injuries need to address their muscle weakness. Let's pretend a person has some hip weakness. Hip strength is important in stabilizing the pelvis and lower leg during a running gait. Weakness leads to a "hip wobble" that makes the run less efficient, and it places more stress on the lateral knee.

This is a common situation for someone who says they start developing pain every time they run more than seven miles. This runner's hip muscles are strong enough for four mile runs, but then the hip muscles fatigue. The wobble begins to increase and more stress is placed on the knee with increasing mileage. So from mile four to five the knee is absorbing more stress that the first four miles. After mile five the hip muscles are tiring and the knee is absorbing more stress and strain. By mile seven the hip is exhausted and the knee is absorbing way too much stress. Eventually this will lead to IT band injuries. Even though the hip is the "weak link in the running gait" the knee will develop the injury.

Treating Tendon Injuries

Tendon injuries can be successfully treated with proper therapy. Several different types of therapy might need to be utilized depending on the specific situation. We like to use massage therapy to address the muscle spasms and tightness in all of the leg, knee, and hip muscles. Physical therapy strengthens the weak muscles that contribute to the injury and pain. Graston Technique or Active Release Technique (ART) addresses the scar tissue or muscle fascial adhesions. Cold laser is often used to speed healing and decrease inflammation. Multiple home therapies and exercises are also given to speed recovery.

Several foot, ankle, knee, and hip exercises are shown on our Physical Therapy Exercises page.

Benefits of massage therapy and how it helps running injuries can be found on our Chandler Massage Page.