Bottom Line:

No endurance athlete should be injured while training!

“ When dealing with endurance athletes, the truth may be hard to say and even harder to hear:  All non-traumatic injuries are training-related.  All ‘osis’ conditions are caused by overuse.  If you didn’t fall off something or get hit by something, you did something wrong in training.” (Boyle, 2010).

What is an ‘osis’ condition?

Many endurance athletes who think they have tendinitis actually have tendinosis.  Tendinitis is more of an ‘acute’ inflammatory condition.  We can’t really have ‘chronic tendinitis’.  If it’s chronic, it’s probably tendinosis.

Itis-types of treatment do little for tendinosis.

Rest, ice and anti-inflammatories work well for tendinitis in the short term, but remember, continued use of anti-inflammatories can weaken the tendon and delay healing.  In tendinosis, the tendon actually undergoes a structural change from the chronic stress, and is characterized by a degeneration of the tendon.   More specifically, it is caused by a degeneration of the fibrous material known as collagen, from which tendons are made.

Tendinosis can also result from poor initial injury treatment, such as:

1. Continuing to train through pain.

When you have to decide whether a certain activity is appropriate, all you have to do is ask, “Does it hurt?”  This question can only be answered yes or no.  If the answer is yes, you should not participate in that activity, or any other that elicits pain.  Any equivocation in in the pain question like “After I warm up, it goes away” is still a yes answer. Bottom line:  Training activities should not cause pain!

2.  Treating the symptom only, and failing to diagnose and treat the cause of the injury.

Injuries do not occur because of the muscle that is injured. That is very unusual.  You have search to find the source of the problem, as opposed to looking only at the pain site. When a muscle/tendon is injured, the first thing to do is look for for the weak or underactive synergistic muscles and ask why the injured muscle has to do too much work.  What’s not doing its job to cause this other muscle to overwork?

With tendinosis, treatment requires some level of stress (therapeutic exercise and resulting discomfort) to produce the proper remodelling effect.  If there is no discomfort in an ‘osis’ tendon rehab program, you will need to up the stress a bit. Repetitions or external weight should be increased.  With the proper amount of stress, some soreness should and will ensue.  This discomfort should localize to the target tissue and can be painful to the touch, but there should be no swelling and no motion restriction.  This pain will follow a DOMS-like pattern and be gone in two or three days.

Many elite athletes use the avoidance of injury as the measuring stick of success in strength and conditioning, as opposed to quantitative physiological measures of capacity like power, strength, or endurance.  If you are training correctly, you definitely are developing your physiological capacities, and you will be well aware of your progress because this is a cause-and-effect no-brainer. But, if you are injured, you can’t really train or compete effectively, or even participate…and if you try to, you will probably make the injury worse.

Reference

Boyle, Michael John.  Advances in Functional Training: Training Techniques for Coaches, Personal Trainers, and Athletes.  On Target Publications, Santa Cruz, California, 2010.  www.strengthcoach.com