Lesson

History

The origin of tendon injuries is directly related to the type of force that is exerted on the tendon.2 Tendon injuries are mainly produced by the forces of compression, friction, traction, or by different stimuli of little intensity applied repeatedly.

The classic history involves an insidious onset of well-localised pain. This typically warms up as the athlete starts to exercise, feels okay during exercise, then aches again following activity. As time goes on, there is often less of a warm-up effect and the pain persists during exercise. Patients will often also complain of morning pain and stiffness which warms up over a few minutes. Tenderness and swelling are also common complaints.

Beware the patient who presents after a sudden acute popping/snapping sensation – especially when there is major bruising or disability. This can reflect a tendon rupture and may need immediate treatment – immobilisation or surgery. When taking a history from a patient, it is important to consider the various risk factors which may have predisposed them to injury. These must be considered as part of a treatment plan.

Dr Ricard Pruna

Sport and Exercise Medicine

Intrinsic factors

The following intrinsic factors should be considered when taking a history (and conducting an examination).

  • The most common biomechanical problem is hyper-pronation of the foot. In this setting an orthotic or show advice may be considered.2,3
  • Other determinant biomechanical disorders in the appearance of tendinopathies are lateral tibial torsion, tibial varus, pes cavus and dissymmetry of the lower limbs.
  • Gender is also considered a predisposing factor – women are more prone to suffering tendinopathies. This may be due to a reduced capacity to absorb repeated impacts, hormonal imbalances or nutritional shortcomings.
  • Being overweight is also an intrinsic risk factor for suffering tendinopathies.2,4

 

Extrinsic factors

This is often a major contributor in elite football. Poor planning of training schedules or too rapid a progression of load may be contributors. For example, an athlete may be at risk during the pre-season or when they return from a longer-term injury. The type of training surface plays a considerable role. Taking an exercise history is essential.