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92 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 8 technique CLINICAL EXPLORATIONS Biomechanics of Tendon and Ligament Tissue By Whitney Lowe Massage therapists focus a great deal of attention on muscles when addressing clients' pain and injury complaints. However, other soft tissues may also play a prominent role in various pain complaints. Tendon and ligament injuries comprise a significant number of musculoskeletal disorders. Understanding the structure and function of tendons and ligaments and how they are injured helps us construct the most appropriate treatment plans when dealing with them. Let's take a look at some key issues of tendon and ligament structure that influence how they work and how they are injured. STRUCTURE AND FUNCTION Both tendons and ligaments are composed of dense regular connective tissue. However, there are significant differences that are important. These two tissues are most commonly distinguished by their main function: tendons connect muscle to bone, while ligaments connect bone to bone. The functional difference of connecting muscle to bone versus bone to bone is important but can also lead to misunderstanding. For example, the patellar tendon begins at the distal end of the quadriceps muscles and continues to its attachment site on the tibial tuberosity. The patella is a sesamoid bone that is actually embedded within this tendon. Yet, numerous anatomical texts designate the portion of this structure between the distal patella and the tibial tuberosity as the patellar ligament because it is connecting bone (patella) with bone (tibia) (Image 1). It is more important to focus on the structure and function of these tissues rather than simply their anatomical attachment points. The entire connective tissue extending from the distal quadriceps to the tibial tuberosity clearly functions as a tendon and not a ligament despite the fact that the patella is embedded within the tissue itself. In addition, the fibrous composition of the structure is clearly tendinous and not ligamentous. The biomechanical function of tendons is to transmit the contraction force of a muscle to the bone while minimizing the loss of tensile force. Tendons have their collagen fibers oriented in almost an exclusively parallel direction. That gives the tendon the greatest amount of tensile strength to resist forces directed along the orientation of these fibers (Image 2). 1 This parallel fiber orientation allows the tendon to be very stiff so it can transmit the muscle's contraction force more like a wire and less like a rubber band. The capability of tendons to withstand very strong tensile forces is indicated by how infrequently you hear of tendon tearing compared to muscle tearing in strain injuries. The forces a tendon is subjected to are primarily in one direction. However, there are a few locations where tendons may also have tensile loading that is not directly in line with their primary muscle's angle of pull. Tendons of the finger flexors and extensors in the hand are a good example. There are lateral connections between the individual tendons that allow finger tendons to work as a network. 2 These fibrous networks seem to be important in maintaining appropriate space between the flexor and extensor tendons and 1 Infrapatellar tendon is often listed as the patellar ligament because of its connection between the patella and tibia. Image is from 3D4Medical's Complete Anatomy application. Infrapatellar tendon

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