Physio Talks – Tendons and Ligaments Don’t Stretch

Have you ever heard the sports commentator go on about the athlete twisting a knee and stretching a ligament, rolling an ankle and pulling a tendon? Of course you have, and the common knowledge is that it’ll take a week or so for the injury to “come right”. Well, ligaments and tendons don’t just tweak, pull, stretch a bit; they tear. They tear in various amounts. Ligaments and tendons are similar to steel cables in that they can deform about 1.5% of their total length, then the tissue snaps or tears, but does not stretch.
Anatomically, tendons connect muscles to bones, and ligaments connect bones to bones. Also, the capsules that enclose joints help stabilize them and keep the fluid contained and bathing the surfaces are ligaments. For instance, if you sprain your ankle, you’ve torn a ligament. Most of the time, when ligaments and tendons tear, they tear a bit, not completely. The standard terminology for the severity of the tear is grade I, II and III where grade I is less than ½ the diameter of the structure, results in little or no instability and hurts a lot. Grade II is ½ or more the diameter of the structure, may result in some instability and REALLY hurts a lot. Grade III is a complete tear across the structure, always results in instability, and often hardly hurts (except for dislocated joints resulting in torn joint capsules). That is because there is no longer anything pulling on the injured tendon or ligament, it’s just “flapping freely in the breeze” inside, so there is nothing to make it hurt when you move the muscle or joint.
All these tears heal at the rate given for ligaments and tendons in the last article, 3 weeks for the initial healing and 6 weeks before the “glue is set”; 3 months before there is complete healing and the scar is mature. If the tear is grade III, then surgery is very likely needed to mend the part.
So, the next time you’re watching your favourite sporting event and you hear the commentator talking about the athlete pulling his hamstring tendon, stretching his knee ligament or rolling and spraining his ankle and is likely to be out for a week or so, you can turn to your mate and smile your knowing smile while giving your commentary; “Yeah right.” You can also take on board the information for the next time you slip in the paddock and pull your Achilles or fall and catch yourself pulling your shoulder, knowing that even with the best intervention it is likely to be a while before the injury “comes right”.
These comments are general in nature. Be sure to check with your physio or doctor if you are not sure whether they apply to your situation.

Dave RoheDave Rohe is a recently retired physio having practiced in New Zealand since 2004.  He originally qualified in the USA, subsequently practicing in Malawi, Egypt and Cambodia prior to emigrating to New Zealand in 2003.  He has enjoyed management positions in pediatric and adult outpatient facilities as well as taught physiotherapy for 15 years at the University of Georgia.  He is currently living in Parakai with his wife, Sharon Robinson, a local midwife, near his adult children who are working, and one of whom is studying to qualify as a physio through the programme at the University of Otago.  His articles previously appeared in local newspapers in Taranaki and on the blog site sponsored by NZSPT.

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