Lack of stretching can cause injury, and often people think the cure for that injury is to stretch it out. Well, I am here to tell you that not all injuries benefit from stretching. In fact, some are actually made a lot worse by stretching.
Insertional tendinopathy is one example of an injury that is worse off with stretching.
What is Insertional Tendinopathy?
Tendinopathy is an umbrella term for the various types of injury that can affect a tendon, including inflammation and degeneration, and is characterised by pain. A typical presentation of tendinopathy is pain felt in the initiation of loading, such as when you start to run or squat.
Tendon load does not solely come from tension, but there is also an important concept of compression that is often not fully explained.
A good example of a tendon that is compressed is the Achilles. As the Achilles attaches to the heel bone it curves around the edge of the heel (imagine a rope on a pulley curving around a wheel).
Let’s look at the following analogy to help explain. I once towed an old farm car with a tractor, and the rope I used came at a high angle from the back of the tractor down to the front of the car, curved under the bumper and onto the axle where I tied it on. After pulling the car for about 10m the rope snapped, not in the middle of the rope, but where the rope curved under the bumper. The rope had worn itself by rubbing on the bumper.
The compressive load in this scenario is the rope pressing on the bumper of the car. Putting pressure on a rope as it is pulled by the tractor, pulls on the resistance of the car. This is a similar example to how tendons like the achilles, hamstrings and gluteals can compress on bones which they wrap around as they come into their attachment point. Usually the tendon is at a slightly differing angle to their line of force at its attachment as it is compressed around a bone.
Insertional tendinopathy is irritation of the tendon where it attaches onto the bone, which is where the compression occurs. It is characteristically different to the other form of tendinopathy in that the pain source is not in the middle of the tendon, but where the tendon attaches to the bone (at its insertion).
For years, we have been managing insertional tendinopathy through stretches and exercises, often with varied results. The more severe the tendinopathy, the less likely stretching would help. In fact, stretching results in further compression of the tendon at the irritation point, which actually worsens the pain.
For more information on exercises that help improve an insertional tendinopathy see our blog on Achilles Tendinopathy.
If you would like a review of your insertional tendinopathy management come and one of our Physio’s at Bend + Mend. We have three convenient locations in Sydney’s CBD.
