hi everyone rehab safely Mr. Physio here today I will do my first Q&A video to
address the most commonly asked questions in my channel I've picked five
questions that I think are most important in terms of tendon
rehabilitations and I will answer them with some evidence behind so with you do
my answer is no there is why in my first video but I will tell you briefly again
tendons attach muscles to bones and their main function is to maintain
muscle length and tension but also they transmit its elastic force between
muscles and bones that's why muscles can work it's like a
spring but if you put a prolonged stretch on tendons they start to lose
its elasticity meaning they can't function properly, breaking down and
tearing so don't stretch please
my answer based on this study is no
Jill Cook is one of the pioneers in tendon rehab who has published many papers including
this recent one in this study the authors say while the continuum
classifies tendons based on the extent bla bla but the main point here
is they even use the word futile for those treatments directly targeting
damaged tendons like you know friction massage electrotherapy and shock wave
therapy whatever you name it and this is ultrasound imaging where you can see the
damaged tendons as a black hole so basically what they're saying is treat
the doughnut not the hole you have to treat what's left rather than just so
obsessed with what's already gone this else is my third question
again not really they! they further say although the
original continuum paper suggested blah blah blah blah what they mean by the
original paper here is the one published in 2009 where they believed treatments
directly on painful tendons can regenerate the damaged but not anymore
what they're saying now is after ten years of research it'll support their
previous opinion anymore so whatever treatments you're doing on
the actual tendon are old so ten years ago it was believed it is effective but
now it's not once damaged it's less likely the tendons can be repaired so let's not
hope if you can regenerate the damaged tendon rather we have to train the
healthy part of the tendon that's still left to us it is also true even in
healthy people this is a systematic review from Berlin Germany changes in
tendon stiffness are due to adaptation of the material which is Donut
morphological means structural so the structure doesn't change in shape the
whole doesn't get repaired rather the doughnut adapts to take more loading and
get healthier and the other adaptation can occur through mechanical loading which
is exercises
first of all let's have a look at these three types of muscle contractions
the first one is concentric contraction where your muscle gets shortened when
generating power and second one is the eccentric contraction where your muscle
gets lengthened while generating power and the last one is isometric
contraction where your muscle length doesn't change when generating power
there are many evidence about the effects of eccentric exercises in tendon
rehab but there are also some suggesting the type of contraction doesn't matter
and the key principle is to find appropriate loading for each individual
and progress accordingly however to make a normal progressive loading effective
you need a heavy loading intensity which can be quite hard if you don't have any
access to weights or simply just not familiar with weight training so it's my
personal choice to show more eccentric exercises because I believe it is
something you have more control over and very easy to do anytime anywhere but
still effective with all the principles and evidence I've just mentioned applied
I'm trying to show you the simplest exercises because I've seen many many
people not doing exercises because it's just too complicated
therefore my recommendation always starts with muscle massage and isometric
exercises to reduce the initial pain and then you introduce the eccentric on top
of it until your symptoms get better enough to do weight training or
plyometrics whatever just for the next level and precautions monitoring your
pain for 24 hours after exercises Cook said, tendon talks to you 24 hours
later which means if you irritate the tendons with exercises they can react 24
hours later so when you do exercises your pain level should be below 4 out of
10 with 10 being worst pain but if you feel a new pain or increased pain during
after exercises or even in the following day you should go back to your previous
level of exercises with frequent eyes on painful tendon muscle massage and
isometrics and then give it a go again to increase your loading little by
little one thing the researchers are still trying to find is the appropriate
loading for each individual because everyone's different so you shouldn't do
too much you shouldn't do too little so find it yourself will find the
professional who could help you through your long journey because you may need
to address other biomechanical issues so that's the end of my first Q&A video and
I'm thinking to do more videos about tendon rehabilitation thank you for
watching Rehab safely