Wait, Do You Mean Tendonitis??......NOPE!
Tendinopathy
●
Pain located to a tendon or insertion point
○
●
Decreased function and loss of strength at the muscle + tendon
Diagnosis can be made based on patient’s clinical presentation
○
This means that you do not need imaging to make this diagnosis
○
Normal age and activity related changes can be identified with imaging, severity of image likely
does not correlate to severity of symptoms
●
Although it may feel warm, and inflamed, inflammation as hallmark sign is an inaccurate
description of the cause of pain
“ITIS” = Outdated
●
Terminology should match treatment
○ “Itis” leads to non-evidenced based treatment approaches
●
Rest.. only helps symptoms feel better at rest
●
Adjunct treatments available, however none of these shown to cure:
○ Massage (instrumentment assisted, ect.)
○ Dry Needling/Acupuncture
○ Taping
○ Stretching
○ (*Insert one simple FIX given to you by provider*)
So What is The Solution
●
“No medication or injectable treatment to date has been shown to alter
tissue properties; only loading the tendon appropriately can stimulate
remodeling”
● So what is tendon load, and how can I do it correctly?
● Progressive exercise program that incrementally works (loads) the muscle
& tendon, making it stronger to withstand all the demands of your sport and
activity
This is where I can guide to ensure you are doing just the right amount :)
Key Concept #1 of Tendinopathy Rehab
1. Hurt
Harm
● Pain levels do not provide indicator or status of healing
● Pain during exercise does not equate to damage to the
tissue
● Pain will be part of the rehabilitation process, but should
be tolerable- I can help you determine when to push it, or
when to pull back!
Key Concept #2 of Tendinopathy Rehab
2. Do NOT Completely Rest
● Should slowly progress
exercise and variations
to load the tendon and
improve tolerance to
desired activities
Potential Exercise Variations to Utilize During Lower Body Training
Knee Dominant
Hip Dominant
1.
2.
3.
4.
5.
6.
Low Bar Back Squat
Leg Press/Hack Squat
a. Feet high on platform
TRX/ Supported Squat
Bulgarian Split Squat
a. Wide stance
b. Forward trunk lean
Step up
a. Forward trunk lean
Hip Thrusts
1.
2.
3.
4.
5.
6.
7.
High Bar Back Squat
Leg Press/Hack Squat
a. Feet low on platform
Belt Squat
Bulgarian Split Squat
a. Close stance
b. Upright trunk
Platz Squat
Safety Squat Bar
Squat/Front Squat
Spanish Squat
Isolated Knee Extension
1.
2.
3.
Isometric at variable
degrees of range of
motion
Knee Extension
Machine
a. Single leg
b. Double leg
Reverse Noric
Key Concept #3 of Tendinopathy Rehab
3. Time
●
Full recovery can take several months with fluctuating levels of pain
●
Using indicators other than pain can be important to track progress. For instance, being
able to increase weight on the bar, or duration running with the same amount of pain is a
sign of progress.
●
Utilize this opportunity to improve performance by honing in on sport specific skills, as well
as perceived weaknesses
●
Find some extra time to spend with family and friends. This can prevent loss of self-identity,
frustration, and depression which can be common for people recovering from tendon pain.
Practical Programming Application
Frequent Exercise Prescription Given at In-Network Insurance Clinic
A.
Start with Moist Hot Pack and Massage
B.
Bike for 10 Minutes
C.
Kinesio-Tape for knee
D.
Table Exercises that likely include: Bridges, Clams, Straight Leg Raise, Side Lying Leg Lifts,
Dead bugs, ect.
E.
Other “Strengthening”- Squats with 25 lb dumbbell, Step ups/downs, Lateral Band Walks,
RDL with 15 lb kettlebell, Single Leg Balance Throwing Ball to Trampoline
Practical Programming Applications
Example Program Modification in Training with Tendinopathy
A.
Low Bar Pin Back Squat: 3@ 5-6 (~78-82% of 1RM)// 2 sets of ~70-75% of e1RM x 5 reps
B.
3:1:0 High Bar Back Squat: 6 reps @ RPE 6-7; 3 sets of 3 reps at same load
C.
Knee extension: 3 sets of 8-12 reps @ RPE tolerable symptoms progressing to RPE 7-8
D.
a.
3-4 second eccentric, 3 second concentric- timed to metronome
b.
Double or Single leg
Sport Specific Conditioning Customized to Client’s Sport or Goals