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Sports Medicine Update: Tendon Ruptures
By Robert G. Marx, MD MSc FRCSC
Tendons are very important structures for bodybuilders and individuals involved in weight training. They connect muscles to bones and enable the muscles to bend or straighten joints as they contract. If a tendon is ruptured, there are two important consequences for the bodybuilder. The first is that the strength of that muscle will be greatly reduced and, in the case of a complete rupture, the muscle will have no power at all. The second is that the shape and contour of the muscle will be altered because the muscle is no longer held at its normal length. Without the tendon holding the muscle in its stretched position, the muscle will retract giving the patient an asymmetric and cosmetically unsatisfactory appearance. Therefore, in addition to the loss of strength, tendon ruptures are of great importance to bodybuilders because of the resulting appearance of the muscle.
Unfortunately, tendon ruptures are relatively common in bodybuilders, weightlifters and strength athletes. There are several factors that can contribute to a tendon tearing. The most common mechanism of injury is a forceful eccentric contraction. There are many types of muscle contraction. A concentric contraction is when a muscle contracts and it shortens in length, such as a dumbbell curl. The eccentric portion of the contraction occurs during the negative portion of the repetition. In cases where the eccentric contraction is rapid or uncontrolled, the tendon is at risk for rupture. In this situation, the muscle-tendon unit as a whole is lengthening rapidly, but the muscular portion remains in a contracted state. This places the tendon under a large stress and in certain cases, it will tear. The lifter will feel sudden pain and will generally be unable to continue the workout. Swelling occurs rapidly and there is often significant bruising in the area.
There are many tendons in the body that can rupture as described above. The mechanism of injury for each is different but the result is the same in terms of weakness. The most common tendons to rupture in the upper limb include the biceps, triceps, pectoralis major and the rotator cuff. In the lower extremity, the common tendons that rupture are the patellar tendon, the quadriceps tendon and the achilles. The diagnosis can be relatively simple for certain ruptures, such as the biceps due to the obvious deformity. For other ruptures, such as the rotator cuff of the shoulder, physical examination alone may not be sufficient to make the diagnosis and MRI (magnetic resonance imaging) is required. MRI uses a large magnetic field to stimulate the tiny particles that make up our body (protons) to vibrate in a fashion that allows the differentiation of the various soft tissues. This technology, which continues to improve, allows physicians to visualize the structure of tendons and ligaments that was not previously possible.
There are many risk factors for tendon rupture, but the most common predisposing factor for individuals involved in physical development, and particularly competitive bodybuilding and strength competition, is the use of anabolic steroids. These drugs lead to increased muscle strength, as well as weakening of the tendons1-4. Laboratory studies have demonstrated that anabolic steroids administered to rats caused a decrease in the elasticity of the tendon as well as a decrease in the load required to cause tendon rupture. However, research to evaluate the microscopic appearance of the collagen fibrils in tendons of rats treated with anabolic steroids did not demonstrate differences as compared to untreated animals. In humans, the combined increase in muscle strength with a potentially weakened tendon increases the rate of tendon rupture for patients who use anabolic steroids. However, many patients who have never used any form of anabolic agents also sustain tendon ruptures when training.
Surgery is recommended for patients who rupture tendons and wish to return to their normal activities. Surgery is best performed within two weeks of the acute rupture to prevent muscle atrophy and degeneration. Certain tendons cannot be repaired if too much time elapses after the rupture because the muscle will retract and not be of sufficient length to allow tendon repair. For example, a biceps tendon rupture cannot be reliably repaired in a successful manner beyond six weeks after the initial injury.
The technique for surgical repair varies depending on which tendon is torn. In recent years, significant progress has been made with respect to surgical devices and technology to repair torn tendons back to bone. Metal devices known as "suture anchors" are now used for the surgical repair of many tendons. These implants are inserted into the bone firmly with very strong sutures attached to them. The sutures are then sewed into the tendon to repair it to the bone. In the shoulder, these devices can be inserted arthroscopically, which allows rotator cuff repairs to be performed without a large incision or any surgical dissection, allowing for a faster recovery. In the elbow, suture anchors can be used to repair biceps tendon ruptures using a single incision, rather than the two incisions that were used prior to the development of these tools. For tendon ruptures at the knee, the tendons are best repaired using drill holes through the patella (knee cap) due to the size and quality of this bone.
Although the surgery is challenging and technically demanding, the rehabilitation following these repairs is critical. Depending on the tendon repaired, there may be a brief period of immobilization, followed by early passive motion. Motion is important to restore normal joint function and to prevent stiffness. However, the tendon requires time to heal back to the bone prior to being subjected to stresses. Passive motion occurs when the joint moves without any contraction from the involved muscles. Six weeks following surgery, the joint can be moved actively by the patient, but without resistance and a month later, they may resume strengthening in a gradual fashion. Fortunately, patients are able to recover normal function following tendon ruptures, but prompt diagnosis and meticulous surgery followed by properly supervised rehabilitation is essential to allow a full recovery and return to training.
References
Dr. Marx is an orthopedic surgeon specializing in sports medicine. He is Orthopedic Director of the Sports Medicine Institute for Young Athletes and the Director of the Center for Clinical Outcome Research at the Hospital for Special Surgery in New York City, which is ranked second in the United States for orthopedic surgery by the U.S. News and World Report. He is also assistant professor of orthopedic surgery at Weill Medical College of Cornell University. His clinical interests include arthroscopic surgery, shoulder and knee instability, shoulder and knee joint replacement, rotator cuff disease and tendon repair surgery.
Dr. Marx has lectured nationally and internationally on sports medicine and related topics. He has published numerous peer-reviewed research papers in leading orthopedic journals, as well as book chapters and a textbook. Dr. Marx has also received a number of awards and grants for his research in the area of sports medicine and orthopedic surgery. He serves on the Editorial Advisory Board for the publication Muscle and Fitness.
Dr. Marx has treated many professional athletes. He has been active in physical fitness and weight training for twenty-five years and he has operated on numerous bodybuilders, strength athletes and fitness enthusiasts.
[source: IFBB.com - Reports and News ]
By Robert G. Marx, MD MSc FRCSC
Tendons are very important structures for bodybuilders and individuals involved in weight training. They connect muscles to bones and enable the muscles to bend or straighten joints as they contract. If a tendon is ruptured, there are two important consequences for the bodybuilder. The first is that the strength of that muscle will be greatly reduced and, in the case of a complete rupture, the muscle will have no power at all. The second is that the shape and contour of the muscle will be altered because the muscle is no longer held at its normal length. Without the tendon holding the muscle in its stretched position, the muscle will retract giving the patient an asymmetric and cosmetically unsatisfactory appearance. Therefore, in addition to the loss of strength, tendon ruptures are of great importance to bodybuilders because of the resulting appearance of the muscle.
Unfortunately, tendon ruptures are relatively common in bodybuilders, weightlifters and strength athletes. There are several factors that can contribute to a tendon tearing. The most common mechanism of injury is a forceful eccentric contraction. There are many types of muscle contraction. A concentric contraction is when a muscle contracts and it shortens in length, such as a dumbbell curl. The eccentric portion of the contraction occurs during the negative portion of the repetition. In cases where the eccentric contraction is rapid or uncontrolled, the tendon is at risk for rupture. In this situation, the muscle-tendon unit as a whole is lengthening rapidly, but the muscular portion remains in a contracted state. This places the tendon under a large stress and in certain cases, it will tear. The lifter will feel sudden pain and will generally be unable to continue the workout. Swelling occurs rapidly and there is often significant bruising in the area.
There are many tendons in the body that can rupture as described above. The mechanism of injury for each is different but the result is the same in terms of weakness. The most common tendons to rupture in the upper limb include the biceps, triceps, pectoralis major and the rotator cuff. In the lower extremity, the common tendons that rupture are the patellar tendon, the quadriceps tendon and the achilles. The diagnosis can be relatively simple for certain ruptures, such as the biceps due to the obvious deformity. For other ruptures, such as the rotator cuff of the shoulder, physical examination alone may not be sufficient to make the diagnosis and MRI (magnetic resonance imaging) is required. MRI uses a large magnetic field to stimulate the tiny particles that make up our body (protons) to vibrate in a fashion that allows the differentiation of the various soft tissues. This technology, which continues to improve, allows physicians to visualize the structure of tendons and ligaments that was not previously possible.
There are many risk factors for tendon rupture, but the most common predisposing factor for individuals involved in physical development, and particularly competitive bodybuilding and strength competition, is the use of anabolic steroids. These drugs lead to increased muscle strength, as well as weakening of the tendons1-4. Laboratory studies have demonstrated that anabolic steroids administered to rats caused a decrease in the elasticity of the tendon as well as a decrease in the load required to cause tendon rupture. However, research to evaluate the microscopic appearance of the collagen fibrils in tendons of rats treated with anabolic steroids did not demonstrate differences as compared to untreated animals. In humans, the combined increase in muscle strength with a potentially weakened tendon increases the rate of tendon rupture for patients who use anabolic steroids. However, many patients who have never used any form of anabolic agents also sustain tendon ruptures when training.
Surgery is recommended for patients who rupture tendons and wish to return to their normal activities. Surgery is best performed within two weeks of the acute rupture to prevent muscle atrophy and degeneration. Certain tendons cannot be repaired if too much time elapses after the rupture because the muscle will retract and not be of sufficient length to allow tendon repair. For example, a biceps tendon rupture cannot be reliably repaired in a successful manner beyond six weeks after the initial injury.
The technique for surgical repair varies depending on which tendon is torn. In recent years, significant progress has been made with respect to surgical devices and technology to repair torn tendons back to bone. Metal devices known as "suture anchors" are now used for the surgical repair of many tendons. These implants are inserted into the bone firmly with very strong sutures attached to them. The sutures are then sewed into the tendon to repair it to the bone. In the shoulder, these devices can be inserted arthroscopically, which allows rotator cuff repairs to be performed without a large incision or any surgical dissection, allowing for a faster recovery. In the elbow, suture anchors can be used to repair biceps tendon ruptures using a single incision, rather than the two incisions that were used prior to the development of these tools. For tendon ruptures at the knee, the tendons are best repaired using drill holes through the patella (knee cap) due to the size and quality of this bone.
Although the surgery is challenging and technically demanding, the rehabilitation following these repairs is critical. Depending on the tendon repaired, there may be a brief period of immobilization, followed by early passive motion. Motion is important to restore normal joint function and to prevent stiffness. However, the tendon requires time to heal back to the bone prior to being subjected to stresses. Passive motion occurs when the joint moves without any contraction from the involved muscles. Six weeks following surgery, the joint can be moved actively by the patient, but without resistance and a month later, they may resume strengthening in a gradual fashion. Fortunately, patients are able to recover normal function following tendon ruptures, but prompt diagnosis and meticulous surgery followed by properly supervised rehabilitation is essential to allow a full recovery and return to training.
References
- The effects of anabolic steroids on rat tendon. An...[Am J Sports Med. 1995 Mar-Apr] - PubMed Result
- The effects of anabolic steroids on collagen synth...[Am J Sports Med. 1992 May-Jun] - PubMed Result
- Anabolic steroid-induced tendon pathology: a revie...[Med Sci Sports Exerc. 1991] - PubMed Result
- The effect of anabolic steroids on the biomechanic...[J Bone Joint Surg Am. 1992] - PubMed Result
Dr. Marx is an orthopedic surgeon specializing in sports medicine. He is Orthopedic Director of the Sports Medicine Institute for Young Athletes and the Director of the Center for Clinical Outcome Research at the Hospital for Special Surgery in New York City, which is ranked second in the United States for orthopedic surgery by the U.S. News and World Report. He is also assistant professor of orthopedic surgery at Weill Medical College of Cornell University. His clinical interests include arthroscopic surgery, shoulder and knee instability, shoulder and knee joint replacement, rotator cuff disease and tendon repair surgery.
Dr. Marx has lectured nationally and internationally on sports medicine and related topics. He has published numerous peer-reviewed research papers in leading orthopedic journals, as well as book chapters and a textbook. Dr. Marx has also received a number of awards and grants for his research in the area of sports medicine and orthopedic surgery. He serves on the Editorial Advisory Board for the publication Muscle and Fitness.
Dr. Marx has treated many professional athletes. He has been active in physical fitness and weight training for twenty-five years and he has operated on numerous bodybuilders, strength athletes and fitness enthusiasts.
[source: IFBB.com - Reports and News ]
