Background with a bit of necessary science!

Tendinopathy can be a right pain! Subsiding with rest, giving you the impression it has improved, only to rear its ugly head again when you return to training.

If you read part I of this series Tendinopathy – What’s It All About you’ll know that persistent tendon pain, also known as tendinopathy, comes about because the process of cell breakdown is occurring quicker than cell repair. It is not an inflammatory condition and therefore rest, ice, compression, elevation won’t cut it. (Side note – RICE is very outdated. Read more about that here)

We need to stimulate a shift in the cell breakdown-synthesis cycle or spark new cell synthesis around the dysfunctional tissue.  

Sounds difficult, where do I start?

Conducting an assessment to work out where you are on the tendinopathy continuum is useful to prescribe the correct level of rehab. However, without an assessment there are a few safe tips that you can try.

During this time the stress to the tendon is high but it isn’t provoking cell breakdown. Why these exercises calm pain isn’t well understood but we do know isometrics won’t fully reverse the breakdown process. It’s how we capitalise on this pain reduction that will count towards long-term improvements and an improvement in tendon health.

Tendons enjoy high load, low repetition. In practice for Achilles & Patella that’s an exercise involving more than your body weight for less than 10 reps! They dislike low load, high repetition. Now that’s bad news for most tendon sufferers who tend to be runners, tennis players, basketball players, swimmers, all sports, and activities with high exposure time.

But we know that maintaining this balance of collagen degradation and synthesis is crucial and that each bout of activity initially creates a drop in collagen but afterwards synthesis begins peaking around 36 hours. Therefore, it is crucial to keep you training but at a level that doesn’t overload the tendon. Pain provocation, both during and after for the proceeding 24hrs is a good marker. Finding that spot just below your tendon aggravation threshold is where we want you whilst we do the work in the background.

Heavy, slow exercises are key with a focus on ‘time under tension’, that’s how long the tendon is working. Current research suggests that 45 seconds plus of heavy, slow movement is the gold standard for tendon recovery. However, getting to this point can often require phasing, to ensure all muscles & joints are on board with this potentially new form of training.

Have patience & stick to the plan.

Numerous factors dictate how quickly you will become pain-free with tendinopathy. But what’s crucial is you get it under control, learn what provokes it, find your threshold and get a good rehab plan that you stick to.

If you’re ready to let me help you with your painful tendon drop me a Whatsapp or contact me via email here.

References

1.       Tardioli A, Malliaras P, Maffulli N. Immediate and short-term effects of exercise on tendon structure: biochemical, biomechanical and imaging responses. Br Med Bull. 2012 Sep;103(1):169-202. doi: 10.1093/bmb/ldr052. Epub 2012 Jan 25. PMID: 22279080.

2.       Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med. 2016 Oct;50(19):1187-91. doi: 10.1136/bjsports-2015-095422. Epub 2016 Apr 28. PMID: 27127294; PMCID: PMC5118437.

3.       Eckenrode BJ, Kietrys DM, Stackhouse SK. PAIN SENSITIVITY IN CHRONIC ACHILLES TENDINOPATHY. Int J Sports Phys Ther. 2019 Dec;14(6):945-956. PMID: 31803527; PMCID: PMC6878865.

4.       Malliaras, Peter & Cook, Jill & Purdam, Craig & Rio, Ebonie. (2015). Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. The Journal of orthopaedic and sports physical therapy. 45. 1-33. 10.2519/jospt.2015.5987.

5.       Scott A, Squier K, Alfredson H, Bahr R, Cook JL, Coombes B, de Vos RJ, Fu SN, Grimaldi A, Lewis JS, Maffulli N, Magnusson SP, Malliaras P, Mc Auliffe S, Oei EHG, Purdam CR, Rees JD, Rio EK, Gravare Silbernagel K, Speed C, Weir A, Wolf JM, Akker-Scheek IVD, Vicenzino BT, Zwerver J. ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology. Br J Sports Med. 2020 Mar;54(5):260-262. doi: 10.1136/bjsports-2019-100885. Epub 2019 Aug 9. PMID: 31399426.