Athletes make daily decisions to rest, swap focus, or to push relentlessly onward. An advanced level discussion, this article hits the process of tendon healing and repair within the confines of your daily life. We also discuss the difficult topic of self-control and the hallmark of intelligent athleticism to prevent tendon degeneration and tearing. Education on what tendinosis is rounds out the conversation with a firm needed wah-bam of important anatomy.
This article aims to teach you the process of damage that occurs when you push your body too hard. To understanding the damaging process that precedes a tear. This way you can come in with great stories instead of exhilaration and achievement instead of woe-
We cover tendonitis, tendonosis, and a variety of tendon related terms. To break it down for you, here is a list of basic tendon terms to understand:
Tendonitis vs Tendonosis:
Tendonitis- An inflammatory condition primarily seen in youth long jumpers Hallmarked by equal and opposing forces going into the same tendon at the same time. Tension tugs the tendon from both directions.
Tendonosis- A degenerative condition caused by overloading in which the tendon is replaced with a different tissue, usually mucoid or calcific tissues. Instead of inflammation, the tendon repairs itself with another tissue type which continues to fail under aggressive loads predisposing it to ruptures.
The process is what matters. Often not apparent to the average athlete, we can stop a tear from happening. The 'tendinosis process' is something you need to learn about. Occurring BEFORE a tear appears, this process is cumulative and permanent. A DEGENERATIVE process we want to avoid, lets learn how this process occurs and the phases so you can be your best self. Choose to add another workout with the athletic intelligence needed to perform and to improve for decades to come.
Rule #1 Tendons don't just tear.
Lets take a step back. First, think about your body in your youthful form....(Not mentally but physically).
Kids don't tear tendons. Soft and flexible and more cartilage than bone in some cases, kids do a variety of idiotic (and informative) activities usually without any real injuries.This is the time that they learn body position, motion, and build up their tissues for their adult form. They might break a bone, or dislocate a joint, but the tendons are resilient and flexible. Tell them to take those falls, hit those jumps, and to learn about balance and technique. They are so resilient!
As the body ages into the 20's and 30's (and beyond), these tendons are stiff and predisposed to injury. This childlike flexibility is gone and so is the sky-high limit to what we can do to ourselves without rest and watching our loads. Tendon and joint structures become more susceptible to damage. It no longer makes sense that we can push the body to behave as it did back during kickball or at day-camp. Unless we have kept it up since childhood, this unannounced activity is now asking for a tear or a rupture.
This is where the intelligent athleticism piece comes in. Listening and constantly taking tabs on what your body tells you will help you negotiate this new territory. If you train your body to do these things (and don't sneak it up on yourself) with focus and perspective, you can get back into the flow...but without all the explosive risky stuff unless you are willing to risk the consequences.
The signs of pushing too far show up in most athletes daily training if they care to listen to it. Subtle but definitely worth learning, these signs will guide you to learn when damage is taking place:
SIGN #1: A Burning Sensation.
A different type of burning than if you sit in a ski squat for too many minutes.... This burning at the site of a tendon will occur often close to a joint such as the knee, elbow or finger. You might feel it on the back or underside of the finger with load, or on the side of your knee when stepping up or down. The burning is usually momentary with the first overuse injury and can become constant for hours after injury if loading and use persist. The burning might be followed by swelling later that night or soreness the next day. If you felt it, you DIDN'T imagine it. You'd be surprised how many athletes come in to ask me this very question. Athletic intelligence is listening to your body on the first sign and writing it down. You don't need to keep pressing on it or re-testing it. My best guidance is to respect what your body tells you.
The burning is your body telling you on a microscopic level, that something is wrong. In the lab, we've learned that this means the sinewy-fiber composition of tendons is being damaged.We can see it on an ultrasound!
Sign #2: Minor swelling.
Any type of swelling that isn't full body or directly related to hot days is a sign that inflammation and damage have taken place. Pain occurs last, long after this chemical stew of swelling has pooled. Compare that joint ot the other side. It might be a tiny bit of visualized puffiness or tenderness to touch that lets you know that its there. Try bending the joint, does it bend less than it did before use? If so, swelling is present, even though you cant see it. Its deep in the joint and/or around the tissues that have been injured.
Sign #3: Pain, the biggest Scream your body can make.
If you feel pain, that is the biggest 'talk' that your body can give you that it's unhappy with you. Choose to listen to the more muted whispering or nudging that the body uses to let you know that something is wrong. Before pain sets in, stiffness and/or swelling are where you truly start to learn intelligent athleticism. Improve within your body's boundaries. Pushing and fighting them really aren't in your best interests. It might not be felt as pain, it might be a pressure, a shooting traveling sensation, a feeling you just cannot describe. These are all sensory communications that your body wants your attention, and the hallmark of listening to yourself. The first time you listen to this, imagine me giving you a High five! It's going to take time to hear it all, thats ok. Learning languages isn't easy.
Use visual and sensory signs as a guide to modify habits.
Choose to guide your athleticism based on these symptoms (and not on your goals, which leave you empty with success and disrepair). Its not worth it to win the war if you kill all your men and blow up your entire country in the process.
On a training plan? If you have these signs, this training plan is now on pause. Seriously. If it isn't you really need to think about what is important. If breaking that mile record, or climbing that 5.15 is, then so be it. Otherwise, take a 2 week break (cross training like mad) while unlading your injury with hitting your healthcare heavy. We then re-evaluate. It might be your training plan isn't YOUR training plan. Often they are made for an end goal or for someone else's body, not meeting you where YOU are. I've paid $150/month for this same problem. Sit down and discuss this with your coach if this is you. Take a break, find your errors, and re-solidify the wall Corporal!
Are you a climber? (Skip this section if you aren't).
Climbing specific activities such as campusing, hangboarding and bouldering are the biggest risk factors seen in my office preceding a tear. These athletes also have high re-injury rates and low long term outlooks as compared to other climbers. If you like crimps, you don't need to train them to climb them outside. Instead choose openhand and save the crimps for when it matters.
It pays to understand what this means so you are making an informed decision about how you use up your important resources of tendons, joints and muscles. Enjoy them aggressively over a few short years, or enjoy them long term with less time off. I have many boulderers who climb gently and don't do dynos that have beautiful fingers. Those who push hard and don't climb on varied terrains sustain more injuries period.
Making Heads of Tails of your Symptoms.
In most cases, tendon damage and degeneration are occurring if you are exhibiting any of the above signs or symptoms. This is called tendonosis (also spelled tendinosis).
Tearing these delicate tendon structures irreparably, the body and beginning a degenerative process that we would hope to avoid. Diagnostic ultrasound can help us to visualize much damage you have accumulated. We then modify habits, climbing or running style, and make supporting modifications to self-care routines.
The kicker is that if you load your tendon while it is healing from this damage, it will repair with the WRONG tissue. This weaker or less flexible tissue is easier to tear, leading you further down the rabbit hole toward degeneration. Tendon rupture occurs on the backdrop of tendinosis. A process that devolves your tendon, a normal fibrous sinewy rope, to a weaker mucoid tissue that is susceptible to ruptures, tendinosis needs to be understood by each climber and evaluated with each climbing trip.
Doctors Note: I'm sure, in reading this, a few of you are getting really terrified by now. It is not my goal to scare you but to let you know what is occurring so you can decide whether to nurture and restore your tissues, or whether you make the informed decision to press on with that additional weekend warrior session without taking the steps to negate the negtive effects of this process. With this said, I have many strong climbers whose fingers look pristine on an ultrasound after decades of climbing however their outlook on climbing (and cycling, and running) has the hallmarks of an evaluative process that is very important in ensuring the long-term enjoyment of their favorite sport.
Ultrasound Tells no Tales.
Want to know what is going on? I offer Diagnostic ultrasound. ($250 on average from facility to facility) The most cost effective, highly sensitive, minimally invasive form of advanced imaging, we can load the regions to test for stability at the same time seeing beautiful images without risk or damage to the patient. No dyes need to be injected, no cuts need to be made, no radiation is created as it uses sound waves and the kicker is that the cost can be 10% of an MRI.
What you can see on an ultrasound:
Arthritis, Bone Spurs, tendinitis, tendinosis,tendon split tears (longitudinal), Partial or Full thickness tears, Bony avulsions, and joint damage/instability.
What does TENDINOSIS Look Like?
Viewed on diagnostic ultrasound, your tendons to your fingertips as well as the fibrocartilage over your finger joints has a very specific visual appearance. The process of tendonosis, has 3 visual signs that you should have examined to ensure you don’t create long term damage.
3 Visual Changes of Tendonosis (Ultrasound):
Tendon Thickening. We will see a larger, thicker structure as compared to normal.
Fading (hypoechoic) non-uniform tendon. The structure loses its brighter visual signal as tissue fiber disruption occurs.
The good news is that with time off, your body DOES go in and heal these tissues, but the tendons are not reinforced back to the same tissue. This is where a buildup of these injuries results in a horrific tear. Instead of filling the tear back in with tendon tissue, the body replaces the region with one of three tissues: mucoid tissue, cacifiic tendonosis (calcium deposits, which fail under shock load), or neovascular tissue (abnormal tissue with blood flow that should not be there) will fill these damaged spaces.
If micro-tears are already occurring, and you are hang boarding or easy climbing through this process, you might not get a happy outcome. A few small fiber tears aren’t the end of the world. A climber can climb for decades symptom free if they understand and respect these processes. Don’t be afraid to find at what point you are on this process. This ensures the least risk of damage and/or chronic injury.
The hard cold fact is that surgery will NOT fix these issues. Once earned, this cannot be undone. For these reasons, please do NOT hangboard or campus on any achy or unhappy fingers and listen to your body to ensure that you are catching these before they progress. We can’t fix what has been earned, but we can pause this process and keep it from progressing.
Diagnostic Ultrasound will show where you are on this process. The above visual markings, in addition to looking for additional fluid, tears, or stability issues gives us the big picture about how much time you need to take off (and how much self-care and climbing modifications you need to adopt to manage this region so it does not progress. For example, if you have a highly tendinotic finger, you might not hold on if your foot pops, it might not be worth it for you to waste your tissues on a nasty warmup climb you aren’t even enjoying, it might not be worth it to finish that training program for short term gains. This is where proper guidance and medial attention can help you to make the right decisions and to find solutions that you can live with.
Ask your local provider to evaluate your fingers if you would like to learn more about where you fit into this spectrum. If you have no pain, swelling or stiffness with climbing, you shouldn’t worry- its those with the above symptoms that we want to educate and prevent from injury.
Remember, you are the guide on your journey. Listen, modify and prepare for improvement!