Two types of soft, fibrous connective tissue in the body that support muscles and bones are known as tendons and ligaments. What’s the difference between a tendon vs ligament?
The easiest way to remember the difference between tendons and ligaments is fairly simple:
- Ligaments attach a bone to a bone
- Tendons hold a muscle and a bone together
At the onset of any soft tissue injury, most of us are usually more focused on the pain and inconvenience of the injury than anything else. But understanding the difference between a ligament vs tendon is important for a speedy recovery and a return to action, especially for athletes.
In ligaments, the fibrous tissue is interwoven in a crisscross pattern, similar to the fibers found in a strong rope. This type of connective pattern provides flexibility, stability, and strength necessary for optimal efficiency of the bone joints.
On the other hand, the fibers found in tendons run in a parallel fashion that provides support, but allows for more elasticity. As muscles begin to work, tendons pull the bone into action.
This combination of soft tissue provides bones and muscles with enough cushion and support to spring into action in one coordinated moment.
With a ligament or tendon injury, though, the body’s ability to react and perform as usual can range from significantly decreased performance to down right impossible to use at all.
Tendon vs Ligament Injuries
Most connective tissue, like tendons and ligaments, are made of collagen, and over time the body produces less of it. Aging is a key reason why senior veteran athletes, and people in general, suffer more injuries as they get older, and reduced collagen production plays a role.
Injuries to tendons vs ligaments show many similarities, but there are noticeable differences in the types of injuries and the reasons.
Ligament Injuries and Sprains
There are approximately 900 ligaments in the human body, from a ligament in the foot all the way up to the neck and jaw. While ligaments are essential to help prevent friction between bones, they have a limited stretch capacity.
An overstretched or torn ligament is considered a “sprain.”
Sprains can happen as a result of a significant collision or blow, an overly sharp or violent twisting of a joint, or from a particularly forceful fall.
In each of these cases, the impact hyperextends the ligament and causes damages to it.
Some of the more common ligament sprains include:
- Ankle Sprain
- Knee Sprain
- Wrist Sprain
Sprains can be incredibly painful and debilitating. They range from a relatively mild hyperextension to a partial tear, or to a severe sprain, where a complete ligament tear leaves the joint totally unsupported.
Even repeated mild sprains in one joint can result in the ligament becoming attenuated, meaning it loses the ability to properly heal and cushion the joint.
Tendon Injuries and Strains
Depending on a person’s size and muscle mass, there are about 4,000 tendons in the human body. Though they are more elastic than ligaments, they can also be damaged by overstretching, sometimes leading to a tear.
Tendon injuries are commonly referred to as “strains” or sometimes certain types are known as “tendonitis.”
In many cases, tendon injuries are the result of overuse from repetition. Repetitive athletic movements, like those in golf, tennis, baseball, and other sports, often result in a tendon strain or tendonitis.
Repetitive movements that lead to injury are not exclusive to sports activities and also frequently occur in some occupations such as the construction and manufacturing industries, where continued stress on the tendons can lead to strains or tendonitis.
In some instances, a snap may be felt or pop might be heard or felt at the time of injury due to subluxation.
Subluxation occurs when a tendon slips or moves from its normal position caused by trauma to the tendon.
Some of the more common tendon strains include:
- Achilles Strain (attaches calf muscle to heel bone)
- Hamstring Strain (or Hamstring Tendonitis)
- Shoulder Strain (or Shoulder Tendonitis)
Symptoms of Injured Tendons and Ligaments
One of the reasons it can be difficult to tell the difference between an injury to a tendon vs ligament is that both have similar symptoms, such as pain, inflammation and a potential decrease in range of motion.
Sometimes sprains and strains are so mild a person barely notices the slight discomfort and continues to engage in activity that places additional stress on the soft tissue.
Over time, this can worsen what was initially a minor issue, so it’s important to speak with a doctor or other medical professional at the first sign of a possible injury.
Do X-Rays Show Tendon Damage?
Unfortunately, x-rays do NOT show tendon or ligament injuries. X-rays are mainly designed to show injuries to bones and joints, but not soft tissue areas like tendons, ligaments, or cartilage, according to the American Academy of Podiatric Sports Medicine (AAPSM).
Physicians are sometimes able to diagnose tendon strains or tendonitis by examining a patient, reviewing the symptoms, and considering their recent physical activity.
In other cases, a doctor may request an MRI (magnetic resonance imaging), which does provide images of soft tissue like tendons and ligaments, as well as bones, joints, and cartilage.
An ultrasound (sonography) is another method for diagnosing soft tissue injuries to tendons and ligaments through the use of high-frequency sound waves.
MRIs and ultrasounds are both painless imaging techniques that are safer and more precise than x-rays and they don’t produce any radiation, making them better procedures for examining injuries to ligaments and tendons.
Types of Treatment for Injured Tendons and Ligaments
At the first sign of any injury, it’s crucial to have a proper diagnosis from a medical professional to identify the type of injury so that the appropriate treatment regimen will be followed and the injury doesn’t worsen.
It is necessary to identify whether the injury is inflammation from tendonitis, an acute or degenerative tear, subluxation, or something else entirely. Knowing this will help determine the treatment methods to be used and the approximate time needed to suitably heal and recover.
Here are 6 Types of Treatment Methods for Injured Tendons and Ligaments:
1. RICE (Rest, Ice, Compression, Elevation)
For mild to moderate tendon or ligament injuries, the first treatment approach is generally the RICE Method (Rest, Ice, Compression, Elevation). This is most effective right after an injury, although serious injuries are likely to require a more comprehensive treatment plan.
The Basics of the RICE Method include:
- Resting allows time to reduce inflammation and pain and gives the affected area a much needed break
- Ice reduces the swelling and sometimes helps ease the pain
- Compression from a bandage wrap or strap immobilizes the injury from additional damage and can decrease swelling and increase healing
- Elevating an injury above the heart sometimes decreases pain and swelling
2. Anti-Inflammatory Medication
In the case of chronic tendonitis, over-the-counter anti-inflammatory medications like ibuprofen found in Motrin or Advil may be useful, for reducing inflammation and pain.
Corticosteroids, or simply steroids, can be given orally or by injection to the affected area to decrease inflammation and promote healing.
3. EPAT Shockwave Therapy for Tendon and Ligament Injuries
During recovery, EPAT Therapy is one of the most effective methods for reducing the time it takes to heal injured tendons or ligaments.
EPAT Therapy is a regenerative treatment method that delivers impulse pressure waves deep within damaged soft tissue, which is why it is sometimes referred to as “shockwave therapy.”
During an EPAT session, the treatment breaks down scar tissue in the affected joint, stimulates blood flow to the area, and decreases pain and inflammation.
Because EPAT Treatment is non-surgical, there is no anesthesia necessary, no scarring, and no risk of infection. In some cases, athletes can actually undergo treatment sessions while still maintaining high levels of performance even as they continue to recover from their injury.
Because of the many positive benefits to treating and healing pain and injuries, EPAT Therapy is quickly gaining popularity among sports medicine professionals, in addition to college and professional athletics training programs.
For ruptured or torn ligaments, surgery is sometimes the best option for reconnecting the soft tissue or adding extra support in the affected area. Subluxation sometimes requires surgery in severe cases.
Surgery is generally only used for the most severe injuries to tendons and ligaments and it causes the most downtime for athletes.
5. Physical Therapy
Physical therapy can be used to strengthen the damaged tissue and teach the patient proper movement techniques that lessen the chance of continued injury in the future. It is also used as a rehabilitation technique following surgery for severe injuries.
6. Cast or Brace
Sometimes an injury to the hand or foot might not be serious enough to require surgery but is still severe and requires a complete immobilization to properly heal.
A severely torn ligament in the foot may require a cast as well as a torn tendon in wrist. These types of injuries can take to 6 to 8 weeks to heal.
In these cases, a cast, splint, or brace is necessary to keep the injured area from moving to heal accordingly. After the cast is removed, physical therapy or EPAT treatments can further speed the recovery process.
Injuries to tendons and ligaments may start as minor pain in the affected area and often go unnoticed for a period of time until the pain becomes more noticeable and has a negative impact on performance.
If the injury is not addressed in a timely manner, it will usually continue to cause problems and may progress to something more severe unless, or until, it is corrected.
The best course of action for tendon and ligament pain is to speak with a trainer or doctor at the first sign of pain to remedy the issue and avoid having it progress to something more serious.
Ligament and Tendon images courtesy of Scientific Animations