Obesity and Increased Tendon Injury Risk

Obesity is a complex condition involving an increased risk of various health conditions, including a number of musculoskeletal injuries. This risk is largely due to high levels of pro-inflammatory cytokines coupled with a high mechanical demand, which promotes chronic low-grade inflammation. Examples of these injuries include hip and knee osteoarthritis and tendinopathies.  

Tendons are connective tissues that attach muscle to bone and allow us to move our skeletons. The Achilles tendon is one example. As the gastrocnemius and soleus muscles contract, they pull on the Achilles tendon, which pulls the foot into plantarflexion. Tendons are made of strong collagen fibres and are not overly extensible. Unlike muscles, tendons have little blood flow resulting in a longer healing time. Tendinopathy is the failure of a tendon to repair, which eventually can result in degeneration of the tendon structure. This term has replaced the term tendonitis. Due to the lack of abundant blood flow, tendons do not actually become inflamed. Along with degeneration, examination of an injured tendon under a microscope reveals disorganization of collagen fibres and increased cellularity. Macroscopic changes include tendon thickening and a loss of mechanical properties.   

Tendinopathy is most commonly caused by repetitive overuse and overload. Research suggests obesity is associated with a higher risk of developing both upper and lower extremity tendinopathies. The tendons most commonly affected in the upper extremity are the rotator cuff tendons and the medial common wrist flexor tendon (aka golfer’s elbow). There is also an increased risk of developing rotator cuff disease, a chronic condition where the tendons of multiple rotator cuff muscles fail to heal. The tendons most commonly affected in the lower extremity are the Achilles tendon, patellar tendon, and plantar fascia. Obese adults are 3x more likely to experience chronic plantar heel pain and foot pain. Along with the increased risk for tendon pain, people who are obese are also at a higher risk for complications after tendon surgery. These complications include wound complications, infections, venous thromboembolism, joint stiffness, and an increased risk of re-tearing the injured tendon(s). 

We all know that physical activity is crucial for managing and treating obesity, but it can be challenging to get moving if you’re dealing with any of these painful conditions. Fortunately, there are things we can do to reduce pain and improve healing capacity. Treatments for tendinopathy include exercises, manual therapy, laser therapy, and shockwave therapy. Specific exercises are used to help strengthen the tendon through eccentric loading. Manual therapy techniques, such as trigger point therapy and instrument-assisted soft tissue mobilization, are used to relax muscle spasms and encourage blood flow. Laser therapy is a non-invasive treatment that uses light energy to stimulate the healing process and speed up the inflammatory process.  

Shockwave therapy is a non-invasive treatment that produces acoustic wave pulsation to accelerate tissue repair and cell growth. Cortisone injections are also sometimes used in the treatment process. Cortisone has not been shown to have any effect on the tendon healing itself, but it can help reduce inflammation in the area around the tendon resulting in a reduction of pain, allowing you to perform your rehab exercises.   

It is important to work with a professional when rehabilitating an injury so that you follow an appropriate program for you and your specific injury to assist the healing process. Contact our Athletic Therapist, Crystal, today to see how she can help you heal faster and stronger and get back to doing the activities you love!    

Crystal Bartkowski
Certified Athletic Therapist

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