Treatment Table Podcast

Mini Consult | Why Different Injuries Feel Different | Muscles, Tendons, Ligaments & Fascia Explained

• Mathew Ah Chow • Season 1 • Episode 17

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0:00 | 11:46

Why does some pain feel tight and achy… while other pain feels sharp, unstable or burning?

In this Mini Consult episode of The Treatment Table Podcast, Doctor of Physiotherapy Mathew Ah Chow breaks down the difference between muscles, tendons, ligaments and fascia — and explains how each structure can create different types of pain, tightness and injury.

You’ll learn:

  • What muscles, tendons, ligaments and fascia actually do
  • Why different injuries create different sensations
  • Common examples of muscle, tendon and ligament pain
  • Why tightness isn’t always caused by “tight muscles”
  • When pain is something to monitor vs something to get assessed

If you’ve ever wondered what your body is trying to tell you, this episode will help you better understand pain, movement and injury in simple, practical terms.

Follow The Treatment Table Podcast for weekly episodes on movement, pain, recovery and living a healthier, more active life.

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See you next week on the Treatment Table!

SPEAKER_00

Welcome to the Treatment Table Podcast. This is your mini consult where I get to take one question, one topic, or one clinical tip and really break it down into an easy takeaway for you. I'm your host, Dr. Physiotherapy Matthew Archow. Let's go. So today's question comes from Sarah. Thank you for sending it through. Producer Renel, do you mind reading out her question?

SPEAKER_01

Okay. Sarah's question is what's the difference between muscles, tendons, ligaments, fascia, etc. And what are examples of like pain or sensations that you might feel from each one?

SPEAKER_00

Thank you, Sarah, for the questions around one of my favorite topics, anatomy. So I was lucky enough to do anatomy twice, not because I failed. I almost failed the first time. But my um exercise science degree was the first time I kind of discovered anatomy. And a lot of it didn't make a lot of sense because I was taught in a sense of rope learning. So you had to learn which muscles attach to where, what bones are where, um, all these Latin names. And it was really just more of a memory exercise. And then when I did my doctor of physiotherapy, it gave me a real chance to think about more of the functional aspect of how this all interrelates, how it works together. And you know, working with cadavers and being able to kind of see how things pull and move on each other really kind of helped the way that I assess, treat, and give exercises as well. Because one of the things, unfortunately, is that the way that we get taught at university and even at school is that the body is so complex and it's so intense that we tend to see things, you know, one chapter will be on the shoulder, and then next semester we'll do something on the back, and the next semester will be the foot. But it's such a complex, interrelated system that it would take too long to bring it all together. And of something that I had to then figure out together. So, although we'll break down today what's the difference between all of these structures, remember that they all correlate together and they all need to work together. And when you have a weakness or a gap in one of those structures, it does affect your whole body. So we'll break down that. We'll also then go down in terms of sometimes there's different sensations, different pain, and different feelings and signals that come from those different structures. And to give you a bit of an idea of how to identify or figure out, you know, is it something that you need to be really concerned about, or is it something that you need to see a physio, or is something that you can just uh manage yourself? So let's dive into muscles. So muscles are the organs that help create movement. So when they contract, they shorten, and the fibers within them pull together. So every time you go to lift something up, those muscle fibers pull together, and there's lots of little micro ones, and then they bundle together into bigger bundles and bigger bundles and bigger bundles, and that all pulls together. So the muscles are fibers. Now, if you interlock your fingers together, what will happen is that those fibers pull and contract on each other. So as they pull in, it's like closing your fists and tightening together, and that's how it creates a pull on the bones. Now, what connects those muscles to the bones is the tendons. So the tendons are a little bit different in terms of how they're made up, they're not made up with all those fibers, they're a lot thicker, they're more like a rope, and that gives a connection between the muscle to the bone. Then what holds the bones together is a little bit different. So the muscles attach to the tendons, to the bones, and within the bones and joints, there are ligaments. The ligaments hold the bones together. So, particularly if you think of your hand, you have lots of bones in your hands and your wrist, and they're not all held together by muscle. So they're held together by ligaments, and they're like the tape that holds everything together. Then we've got fascia as well. So fascia is the interconnective spider web that holds everything together. So we spoke about this early in the season one. So go back and have a listen to that. I think it was episode five. We talk about the fascia as the spider web. So in between all those muscles, the tendons, the ligaments, and the bones and joints, the fascia is a spider web that connects everything and that helps transfer the forces across different body parts and that connects everything together. So coming back to Sarah's question is how do we figure out what pain means what? Is it coming from the muscles? Is it coming from the ligaments? Is it coming from the tendons? So one of the pains that muscles are going to give you, and it depends on terms of the history. So we'll ask you a bunch of questions generally within the clinic to see if it is something that is traumatic. Traumatic being that there's potentially been a direct injury to those muscles, and this is quite commonly your strains or your tears. So that's when something goes snap or you feel a sudden sharp pain. And sometimes in the within those muscles, it could just be soreness. We spoke about that earlier in one of our other mini consults where it's just soreness post-exercise. Now, that pain is gonna be different to a sharp acute pain that could be from a tear within those muscles. Now, tendon pain is gonna be a bit different. Tendon pain, particularly once you've irritated a tendon or if you've overused, particularly what we see. Think of things like your tennis elbow, your golfer's elbow. Um, these are from overuse injuries. And so because you've put too much pressure on that tendon that attaches to the bone, it becomes a more of a dull ache. Now, that ache generally improves once it's warmed up, whereas sometimes if you have a strain in the muscle, it's not necessarily going to improve once you warm up, so that pain might get worse. Tendons are a little bit tricky with their pain because it was gonna start off being uncomfortable, it's gonna warm up, but then afterwards, when you cool down, that pain will increase and you've probably overdone it again.

SPEAKER_01

So then what should you do if it's hurting afterwards? Does that mean you should stop exercising or go see your physio?

SPEAKER_00

Yeah, so with tendon pains, if you're pulling up really sore after exercising, I would definitely recommend go see your physio, get it checked out first because what tends to happen with that tendon is that you'll just keep annoying it. Again, you'll warm up. We see this a lot in runners as well. Is that you'll start running, you'll feel good, that hamstring will start to feel warm, that blood flow will improve, and then you're gonna be sore and hobbling for the next two days. Don't just push through that because the longer you push through that, the more it changes the collagen fibers, and that's kind of like the rope structures within that tendon. The more you disray that and fray it, it doesn't necessarily heal itself. We can improve the capacity of that tendon, but the more you damage it, the worse it's gonna be. So definitely get it checked out with ligaments. So these are connections from your bone to bone. Now, generally, if through direct trauma, a fall, a twist, and jujitsu, you might get someone that yanks on your arm to break it. Now, when you tear a ligament, it is pretty traumatic. Okay, sometimes you'll pull that whole ligament off the bone, and that's what we call a vulction fracture.

SPEAKER_01

I am a massive footy fan. You know that. I love the AFL, and I see a lot of athletes go down with like ACLs and MCLs. Is that kind of what you're talking about?

SPEAKER_00

Yes. So ACL, anterior crucial ligament, is another one of those that we commonly see in sports. And that's why it's such a traumatic thing. When that knee gets rotated, twisted in a certain position with all their body weight on it, that rips, either tears that ligament in half or it will pull off a segment of the bone. And that's where you commonly hear your ACL or your MCL as well. And what tends to happen it is you'll see them go down, they're screaming, they're grabbing the knee. Because it is such a strong ligament to hold things together, it takes a lot of force to rip it and it's very excruciating pain. Even a smile, you can just um it might not be a complete tear, what we call a grade three tear, but if it's a grade two and it's a partial tear, means it hasn't ripped all the way through, it is still quite painful, and you're left with the sense of feeling very unstable and very unsure. So you might go to stand or put weight or lift something, it's gonna feel a bit shaky. You're not gonna feel very confident. And that's again a very good sign that you need to go get some scans or see your physio first, and they can determine whether you need more scans. All right, and then we come back to our fascia. So fascial tightness is generally that stiffness that you'll feel. Um, sometimes it's more in terms of referred pain. So you might get a hamstring that's really tight and pulling on that fascia, which is then causing back pain, neck pain. Um, these are generally things where you'll wake up stiff and sore. There was no specific injury or no specific cause. You might be in uh doing a new workout or been sitting really awkwardly. These are the things that you start to kind of feel over a few days. It gets worse and worse. Um, again, something you can try and do, some foam rolling using a trigger ball to release those fascial points. Um if it's not releasing and not getting better, then definitely get it checked out by your physio as well. Thank you, Sarah, for your question. I could uh spend a long time talking about anatomy and um I try my very best to break it down very simply. Um, it is complex in terms of the body and how it all works together, but at least that gives you a bit of an understanding of what to do when to see someone, if you think it's bad, or when to try and fix it yourself. So, the one takeaway for our mini console today is that think about what is the reason why one of these structures are hurting. Now, if you have no idea why it's hurting, go see someone. If you think the pain is really bad and acute and it feels unstable, like you've done a ligament, go see someone. If it warms up and it goes away after a few days, it's probably just post-exercise soreness, keep going, but keep an eye on it. And that's a wrap for today's mini consult. We've dived into anatomy, and I hope that gives you a bit more understanding of what your pain is and how to fix it and when to see a physio. So we'll see you next week on the treatment table. Don't forget if you have any questions, make sure you send us a DM on Instagram, treatment table podcast, or send us an email with a voice note, or you can just type it in at treatment tablepodcast at gmail.com