Chronic tendon pain is something most runners face at one point or another. When the injury is acute, there is obvious inflammation and tears in the tissue. Time, relative rest, ice and a gradual return to running usually does the trick. These are cases of tendinITIS.
However, once pain persists beyond 6 months, the origin of that pain completely changes. I have written about the subject before here. In summary, the tears and inflammation are gone. The pain persists from a not entirely known mechanism which includes lingering pain neurotransmitters that no longer belong in the tissue, and new blood vessels penetrating into the tissue and bringing pain sensing nerve fibers with them. The tissue is hypersensitive. It has healed after 6 months, but it has not “learned” to be normal again. These are cases of tendinOSIS.
However, once pain persists beyond 6 months, the origin of that pain completely changes. I have written about the subject before here. In summary, the tears and inflammation are gone. The pain persists from a not entirely known mechanism which includes lingering pain neurotransmitters that no longer belong in the tissue, and new blood vessels penetrating into the tissue and bringing pain sensing nerve fibers with them. The tissue is hypersensitive. It has healed after 6 months, but it has not “learned” to be normal again. These are cases of tendinOSIS.
The reason I am bringing this up because I just came across a review study that puts into question a commonly recommended treatment protocol: eccentric loading. Eccentric loading involves putting force through the tissue you are wanting to rehab as you take it from its short to long position. Almost 4 years ago I wrote about the importance of using eccentric loading, and it is something that the research has supported. However, eccentric loading, as I have seen in practice and have long suspected, may not be the magical movement we once thought.
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