Rare are the athletes who have never had to deal with a painful tendinitis at some point. Tendinitis is an inflammation of the tendon, the fibrous structure that connects muscle to bone. It is mainly caused by excessive muscular stress or by unsuitable equipment. In this latter case we speak of technopathy, since it is the equipment that causes the issue.
Main types of tendinitis
Cycling: Patellar tendinitis (below the kneecap) is a classic overuse injury. Tendinitis of the pes anserinus (inside of the knee) and of the tensor fasciae latae (outside of the knee, also called IT band syndrome or “windshield wiper syndrome”) are very often linked to incorrect cleat adjustment (heel too far inward or outward) or to pedal systems that do not allow sufficient angular freedom.
Running: Achilles tendinitis is typically linked to overuse of the calf muscles. IT band syndrome is also a classic running-related form of tendinitis.
Swimming: Shoulder and arm tendinitis are the most frequent.
“Minor” tendinitis is painful at rest but the discomfort disappears during light to moderate effort. Severe tendinitis is painful constantly, even at rest and even more so during exercise.
Causes
The first cause of tendinitis is unsuitable equipment, such as swim paddles that are too large, a poorly fitted bike or poorly chosen running shoes.
In cycling, equipment and/or a poor position on the bike are the origin of most tendinitis cases, and the joints of the leg are the most affected (knee, ankle). This often results from a problem at the lower contact point (pedals) or the upper one (saddle).
Main causes include:
- a saddle that is too high or too low
- a saddle tilted too far forward or too far backward
- a saddle that is misaligned or twisted (at the level of the rails)
- a handlebar that is too low or bent
- a bent pedal axle or crank spindle
- a poorly adjusted shoe cleat (clipless pedals)…
Tendinitis can also result from overuse and from a lack of gradual progression in training. A classic example in swimming is the use of paddles. Very often, introducing paddles too quickly into a beginner swimmer’s training routine generates excessive strain that leads to the onset of shoulder tendinitis.
Tendinitis may also appear after efforts for which the athlete is insufficiently prepared, such as a very long training session or a particularly tough competition. Gradual, progressive increases in training load remain the key principle of prevention. Without progression, all minor anatomical imbalances (one leg shorter than the other, pelvic imbalance and others) can pave the way for tendinitis when the training load increases too quickly.
Finally, tendinitis can occur after a fall, leading to muscle-tendon trauma or bone displacement. Among the “classic” cases are displacements of the spine or pelvis.
Prevention
To prevent the occurrence of tendinitis:
- Equipment. In swimming, avoid paddles before at least one full season of regular training. In cycling, pay careful attention to bike fit and positioning by consulting an ergonomics specialist. In running, take the time to choose your running shoes with the help of a professional.
- Warm-up. It is essential (20–30 minutes), especially in cold weather (a factor that promotes tendinopathy). For a musculo-tendinous structure to function optimally, its temperature must increase so that the joint/muscle/tendon complex is ready for effort.
- Cycling: Spin with a light gear to relieve your knees. Avoid pushing heavy gears and favour a higher cadence (over 70 rpm uphill and over 90 rpm on the flat).
- Running: Start your sessions with 5–10 minutes of joint mobility work. Then try to reduce impact by promoting a smoother foot roll or even landing more on the forefoot.
- Swimming: Start your sessions with 5–10 minutes of joint mobility. Focus on strengthening the external rotator muscles of the shoulder (infraspinatus and teres minor), which perform the opposite action of the propulsive muscles (pectoralis major and latissimus dorsi), thus improving their braking effectiveness.
- Hydration and nutrition. Tendons are fibrous structures that are very sensitive to the body’s hydration state. It is important to hydrate regularly in small amounts to prevent tendinitis, especially during the summer.
Drink enough water throughout the day (a simple sign: urine should be clear). The quantity depends on activity level and temperature (between 1.5 and 3 litres).
If you are prone to tendinitis, try reducing acidifying foods such as alcohol, coffee or black tea, red meat, cheese, cow’s dairy products, sodas and sweets. Conversely, increase alkalising foods, mainly fruit and vegetables, and fats rich in omega-3 (mackerel, sardines, salmon and rapeseed or walnut oil). - Dental health. Oral hygiene is important for both the prevention and treatment of tendinitis. Experts agree that poor dental hygiene (cavities or other issues) can be an entry point for infections. An annual dental check is essential.
Also note that most “sports drinks” have a very acidic pH. Dentists advise athletes to rinse their mouth with water during exercise and to brush their teeth after training. - Posturology and osteopathy. In cases of postural imbalance, muscle chains are placed under uneven tension. With training, overuse develops and may lead to tendon injuries. Entry points may include a prominent scar, ocular or mandibular asymmetry or a foot-related issue.
Consult a posturologist to begin long-term corrective work. And do not hesitate to see an osteopath regularly, especially if you have fallen recently. It is the athlete’s “straightening on the marble”.
Conclusion
If you are prone to tendinitis, progress very gradually when introducing new equipment and take care of your tendons as a preventive measure.
If tendinitis appears, do not push through the pain. Pain should be seen as a warning signal that urges you to slow down and rest.