Inflammation of the tendon and/or tendon sheath is referred to as tendonitis. Small tears can develop causing inflammation that forms scar tissue (adhesions). These adhesions prevent the tendon from gliding smoothly within the tendon sheath. A cycle of swelling and irritation occurs causing chronic tendon problems.

Mechanism of Injury

Tendonitis most often occurs in tendons that are tight and/or weak. It is the result of:

• overuse
• gravity (traction stress)
• posture (rounded shoulders)
• muscle imbalance

In soccer, tendonitis most often occurs at the:

• adductor (from repetitively kicking the ball)
• achilles (from start and stop running)
• hamstring (from sprinting)
• gluteal (from forcefully kicking ball repeatedly)

The following are common places that are prone to irritation in other sports:

• patella (kneecap)
• achilles (heel)
• biceps
• rotator cuff (shoulder)

Inflexible and weak, the patella and achilles tendons can be overstressed by repeated running and jumping activities. Rotator Cuff tendons are usually overstressed when an athlete throws with a weak and inflexible shoulder.

Signs and Symptoms

• Point tenderness to touch.
• Pain with any activity.
• A grating sound (crepitus) is often heard, and can be felt on palpation.
• Sometimes swelling or thickening of the tendon is evident.

On-Site Management

P.R.I.C.E. PROTECT the area from further injury (i.e. evaluate proper body mechanics and body alignment). REST does not imply halting all activity, and the injured athlete can be running in deep water, cycling, etc. to maintain and/or increase fitness. ICE massage 5-10 minutes before and after soccer practice or games can be helpful, talk to a sports medicine practitioner for the proper way to do this. COMPRESS the area to move inflammation away. ELEVATE the area to increase circulation towards the heart.

Refer for a Correct Diagnosis. It is important, as with all overuse injuries, that a correct diagnosis be determined before the cycle of pain becomes established. A sports medicine practitioner will take a history of the injury and conduct a physical examination of the injured area. Physicians will often prescribe anti-inflammatory medication.

Rehabilitation. Physiotherapists can apply various electrical modalities to assist in controlling inflammation.

Promote Healing. Invariably with overuse injuries, when the athlete's pain is relieved s/he prematurely returns to playing soccer and is reinjured. Rest and anti-inflammatory medication alone do not lead to healing. Healing occurs with a combination of progressive site-specific strength and conditioning exercises and overall body conditioning. Active and passive exercises assist in strengthening the surrounding muscles (i.e. hip, quadriceps and hamstring muscles for adductor) as needed. Address socccer movements creating impingement for proper motion and posture.

Control Abuse. The potential for tissue overload must be adequately controlled prior to returning the athlete to soccer. A heel lift, for example, will take the stress off an achilles tendon injury. Persistent achilles tendonitis may be caused by a foot imbalance such as excessive pronation of the foot on landing. Soccer cleat or turf shoe inserts (Orthotics) may be required to alleviate the problem.

Return to Activity. When the athlete returns to soccer, pain should be used as a guide, and the intensity of the activity should not be increased too quickly.

Prevention

• Avoid too much too soon. Gradually work your way back up to speed.
• Proper equipment (i.e. supportive soccer cleats or turf shoes).
• Avoid excessive running on sloping surfaces or hills.
• Proper warm-up and stretching exercises for both practice and games.

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