Tendon injuries

Assessment and treatment of tendon injuries in sports, including tendinitis and ruptures.

Tendon Injuries in Physical Assessment

1. Definition

Tendon injuries involve pathologies of the fibrous structures connecting muscles to bones. They often result from chronic overload or acute trauma, significantly impacting performance and mobility.

2. Types of Tendon Injuries

Injury TypeDescription
TendinopathyGeneric term for tendon pain without rupture.
TendinitisAcute inflammation (rare, often overdiagnosed).
TendinosisChronic degeneration (more frequent).
TenosynovitisInflammation of the synovial sheath around the tendon.
RupturePartial or complete tearing of tendon fibers.
InsertionnopathyPain at the point where the tendon attaches to the bone.

3. Frequently Affected Tendons

  • Achilles tendon.
  • Patellar tendon (knee).
  • Quadriceps tendon.
  • Rotator cuff (shoulder).
  • Epicondylitis (tennis/golfer’s elbow).

4. Causes and Risk Factors

  • Mechanical Overload: Volume, intensity, hard surfaces.
  • Training Errors: Repetitive jumps, sudden intensity changes.
  • Physiological Factors: Muscle imbalance, fatigue, insufficient recovery, age.

5. Clinical and Functional Assessment

  • Clinical Assessment: Localized pain, pain on palpation, tension tests (contraction against resistance), presence of nodules.
  • Functional Tests: Single-leg hop test, Drop jump / CMJ with pain feedback, progressive loading tests (e.g., isometric squat).
  • Imaging: Ultrasound (thickening, vascularization), MRI (deep lesions).

6. Return to Activity Criteria

  • Low pain during effort (<3/10 on VAS).
  • Improved functional performance.
  • Progressive recovery of tolerated load.
  • Full control of sports-specific technique.

7. Prevention and Rehabilitation

  • Eccentric Exercises: (e.g., Alfredson protocol for the Achilles tendon).
  • Strengthening: Progress from isometric to concentric/eccentric work.
  • Postural Control: Work on posture and the kinetic chain.

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