Tendon injury from excessive or overuse is a very common problem in sport. It occurs when the cumulative load on the tendon is greater than what the tendon is designed to take. There is two parts to this: the first is the collective repetitive load and that means just how much activity is taken on and how frequently this is done. It is vital that the tendon has time to get used to those loads or the cumulative load could exceed that. Which is the second part, just how adapted the tendon would be to those loads. Understanding these concepts is very important in being familiar with and managing tendonitis.
For example, peroneal tendonitis
which is an overuse injury that occurs on the outside of the ankle joint. The cumulative load in this tendon is increased when activity amounts are too high or increased too quickly and not sufficient time is given for the tendon to adapt to those higher loads. The cumulative load is also increased by the biomechanics of the feet. For example, if the supination resistance of the foot is reduced then the peroneal muscles on the outside of the leg will be required to work harder. That can put an increased stress on the peroneal tendons after which along with training errors that load could very well go beyond what the tendon can take and it develops tendonitis.
Based upon these principles, peroneal tendonitis
is managed by reducing that collective load. That can mean exercising volumes and frequency need to be reduced somewhat to permit the tendon to adapt to the loads. The load in this disorder will also be decreased with foot orthotics that evert the foot, which means the peroneal muscles does not need to work so hard. Then the tendon really should be given a chance to adapt to the loads. This means that training volume and frequency has to be slowing increased, with lots of rest between training loads to give the tendon to adjust to those loads.
The muscles of the body are held in place by a tissue known as fascia. They are fibrous sheets of connective tissue that what really hold the body together. Normally there is some movement or give in this fascial tissue so that when exercising and muscles expand the fascia moves to accommodate that expansion. In some people the fascia is actually so tight that when exercising and the muscles try to expand they cant and this becomes painful. In the very worst cases of this the expansion of the muscle in the tight compartment results in the blood supply being cut off. This can be very serious. It can also happen in cases of trauma if the muscle expands in a too tight compartment. In runners the most common place to get a compartment syndrome is in the front of the leg where it is called anterior compartment syndrome. Basically it hurts on the front of the leg when running as the muscles expands and stops hurting when you stop running. It is not like a tendon injury where the symptoms persist after stopping the exercise. A clinician can organise testing of the pressures in the compartment to confirm the diagnosis.
Traditionally conservative measure do not work very well to treat this and most cases either resulting in the person just giving up running or having surgery. The surgery involved cut the fascial compartment so that the muscles have room to move. More recently there has been a big trend to move the runners from being a more traditional heel striker to start contacting the ground with the midfoot. This has been shown in two studies to be a very successful way to manage anterior compartment syndrome. The reason for this is that the actual muscle that is involved doe not have to work so hard when forefoot striking compared to heel striking.