While there is good evidence to say that muscle injuries can be prevented (with a strengthening protocol and warm-up) this is not true for tendinopathy. It is actually possible that a strength protocol can precipitate symptoms.
- Primary prevention
- The science relating to the preventive effects of tendon exercise is mixed. While some papers suggest that strengthening and stretching of the muscle and tendon system prevents some injury, others suggest that they can provoke pain. In papers where the pain became worse, there were USS changes consistent with tendinosis which were not painful prior to the exercise programme.
A careful management of loads and early intervention in athletes with tendinopathy is a key factor. When an athlete reports symptoms, their training loads are quickly modified to reduce the overall loading. An individualised training programme is created with regular monitoring in the changes in pain. Isometric exercise is more important in these players.
- Secondary prevention
- Having re-joined training with the rest of the group, any players that have suffered or are diagnosed with Achilles tendinopathy at any time of the season should continue and maintain preventative exercises in order to avoid relapses of the injury for at least 12 weeks at sessions three times a week.
This maintenance work will feature the following characteristics.
- The main exercises done in this maintenance phase will involve therapist-assisted exercise, standing eccentric exercise off a step and using a vibration platform.
- They will be done at least three times a week, before training sessions and after doing a specific warm-up for the exercises outlined above.
- At the end of each session, manual relaxation shall be done along with exercises for the extensibility of the Achilles tendon, at least two times a week.
In cases in which the troubled player follows the same training programmes as their team-mates, the following prophylactic measures should be taken:
- cycling to warm the tendon before training sessions;
- compulsory stretching exercises before sessions;
- massage therapy to pre-activate the calf;
- stretching with active tension before training sessions;
- individualised warm-up – longer and more gradual progression than the playing group;
- following the session, the athlete has further massage and stretching of the calf;
- systematically end sessions with 15 minutes of cryotherapy.
Dr Ricard Pruna
Sport and Exercise Medicine