Optimal Loading for Tendon Rehabilitation

As a physiotherapist having many clients with tendon issues, the biggest question I have is why did injury occur in the first place? Was it due to trauma, is it linked to training loads or is it something else causing effects to the tendons. Our job is to help guide you to have the best rehab getting you back into your sport or activities. This blog will discuss the importance of optimal loading for tendon rehabilitation.

Optimal loading is what physios strive to achieve when talking about rehabilitation, although due to the nature of tissue healing and recovery it can be made difficult to follow a ‘recipe’ program. Therefore we need to adapt our exercises and progress you through the rehabilitation process to get you back to the top of your game.

When deciding what rehab pathway is appropriate we must first look at what stage of injury we are in. There are two key stages of tendon injury, reactive and degenerative. A Reactive tendinopathy can be described as an acute tendon injury where appropriate management strategies would be to de-load the tendon to let the inflammatory process settle down, then proceeding with progressing tendon loading. A degenerative tendon is where symptoms have been present for a while. A good progressive loading program to increase tissue capacity and tolerance to load is needed.

The table below describes the nature of these types of injuries:

Reactive Degenerative
Symptom Acute onset of symptoms, slow to settle down Chronic – long history of symptoms
Age 15-25 30-60
Time 2-6 weeks 3-6 months
Physio management Massage, orthotics, Dry needling etc. Progressive load
Treatment Unload and reload Load,- Heavy and slow

The image below can help us understand the architecture of a tendon. As a tendon injury starts to proceed into a degenerative tendon the striation of the collagen go from being very linear and to being disrupted and become more disorganised.  This demonstrates the change that occurs and therefore it is important to have an appropriate exercise program to prevent further injury.

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Here at Bureta Physio we can help guide you through your injury. We will focus on the injury itself but always ask the question to why this occurred in the first place.

Key points:

  • Depending on the type of injury, we need to work together to establish the best management strategies for rehab
  • Acute reactive tendons may need to be unloaded prior to reloading
  • Chronic degenerative tendons can take months to heal fully
  • As a degenerative tendon develops the architecture of the collagen fibres becomes disorganised. Through loading appropriately we can enable the tendon to be able to adapt to required loading and therefore allowing return to sport.

Please call us on 07 576 1860 to discuss your injury and our team will be more than happy to help.

Written by Braedon Catchpole – Physiotherapist

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How a Warm-Up Routine Can Save Your Knee

As football, rugby, and netball season draws nearer we thought it would be a good time to talk about sporting knee injuries. The most debilitating of all that will promptly put a stop to your season and more than likely have you visiting the surgeon is a injury to your anterior cruciate ligament (ACL).

Recent research suggests that changing how individuals land and how sports teams warm up before practices and games could substantially lower the risk that athletes will hurt a knee.

Injuries to the A.C.L, which connects the tibia and femur and stabilises the knee joint, are soaring. The ligament is prone to tearing if the knee shears sideways during hard, awkward landings or abrupt shifts in direction – the kind of movements that are especially common in sports like rugby, netball, basketball, football, volleyball and skiing.

Motivated by the growing occurrence of these knee injuries, many researchers have been working in recent years to develop training programs to reduce their number. These programs, formally known as neuro-muscular training, use a series of exercises to teach athletes how to land, cut, shift directions, plant their legs, and otherwise move during play so that they are less likely to injure themselves. Studies have found that the programs can reduce the number of A.C.L. tears per season by 50 percent or more, particularly among girls , who tear their A.C.L’s at a higher rate than boys do (girls are 4-6x more at risk than boys, although, numerically, far more boys are affected).

To date, few clubs, schools or teams across the New Zealand have instituted neuro-muscular training, the most easiest of all are the PEP (Prevent Injury, Enhance Performance) program, which was developed by the Santa Monica Sports Medicine Foundation, and the FIFA 11 program, created by the international governing body of soccer. Both programs are free, and take about 15-20mins of exercises useful at ‘priming’ the body for sport which jumping, squatting and side-to-side shuffling movement.

The programs also emphasize landing with knees bent and in the proper alignment, which is where the team at Bureta Physiotherapy can help. When a player lands with the knee in the knock knee position (dynamic valgus in medical terms) their risk of knee injury is hugely increased.

how to warm up before a run

Dynamic valgus can come about from a number of factors – biomechanics, habitual, core/hip strength, foot posture and balance. The physiotherapists at Bureta will be able to teach you how to land properly and if required give you the appropriate exercises to be strong enough to land in this preferred position.

ACL reconstruction is long and involved and we would like the opportunity to protect you, your daughter or son from this injury.

Come in and see us at the clinic to take you through the PEP program or assess your jumping technique.