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

Concussion is a Mild Traumatic Brain Injury.

Concussions – Written by Kimberley Pilbrow (BHSc Physiotherapy)

With the start of another Winter Sports season now upon us, now is a good time for athletes, parents, coaches, officials & supporters to increase their knowledge about concussion.

Concussion is a Mild Traumatic Brain Injury which occurs when someone receives impact to the head or body causing a force to be transmitted to the brain, ie ‘shaking’ inside the skull. In a concussion injury there is no change to the macro-structure of the brain. Ie there is no permanent damage to the brain. However, there are changes at a micro level, meaning it may take some time to re-access the areas of the brain that were affected.

Historically people believed that to sustain a concussion you must be “knocked out” (loss of consciousness), this is not true- 90% of concussion occur without any loss of consciousness AND Loss of consciousness does not relate to their long-term outcomes. Ie someone who is knocked out may return safely to sport in 3-4 weeks, where as someone who is not may take 3months to recover- there is no relationship between “severity” of concussion and length of recovery.

As Concussion is a brain Injury- there is a wide range of symptoms such as:

Visible Signs:
-loss of consciousness
-slow to get up
-unsteady on feet/poor balance
-poor coordination or inappropriate playing behaviour (eg. standing out of position)
-clutching or grabbing at head
-dazed or confused
-vomiting (>once is of greater concern-take to Emergency Department)
-irritability/changes in emotions

Symptoms:
-dizziness
-headache
-nausea
-drowsiness
-“don’t feel right”
-blurred vision
-difficulty concentrating/remembering

If you (or your child) have an incident like this and have one or more of the following symptoms you should:
1) Be removed from sport immediately
2) Monitored by an adult
3) Seek Medical Attention from your GP or Concussion Trained Physiotherapist (Click here for our team)

A full list of symptoms can be found HERE– the Concussion Recognition Tool is a great resource for parents & coaches

Assessment and Treatment of Concussion:
A concussion must be diagnosed by a health professional. Examination from your Physiotherapist will include a group of tests as required including; SCAT5 or SCAT5 Child Assessment (Symptoms, Neurocognitive processing, Balance), Assessment of neck pain and movements, Neurological Exam, and Eye & Head Movements.
Treatment of each concussion is individual- REST IS NOT BEST!!
Your Physiotherapist will work with you on starting appropriate activities EARLY to aide a gradual return to daily activities (highly supported by research), followed by return to work/school and then return to sport. Your treatment plan may include; education about pacing activities, treatment of the neck joints and muscles, relearning eye tracking movements and gradual exercise progressing back to full function including work and sport specific tasks.

Key Points:
-90% of concussions occur without being knocked out
-If you suspect a concussion, remove the athlete from play IMMEDIATELY
-Seek Medical Assessment from someone trained in Concussion
-Rehabilitation is INDIVIDUALISED
-REST IS NOT BEST!
If you have had a concussion, Bureta Physiotherapy will work with you, your family and your doctor to take you through the required steps for full return to function-including sport, school or work.
Early Diagnosis is important for monitoring symptoms and guiding appropriate rehabilitation, contact us TODAY to book an appointment or discuss if our acute concussion service is right for you.

 

 

Abnormalities found on scans in asymptomatic people.

There have been many studies that have explored the abnormalities within our bodies through using different imaging techniques. The key take home message that research has brought to us is we are not all perfect, even if we are walking around pain free performing all our daily activities without issues.
However when injury does occur we may get x-rays, an ultrasound or refer you to a specialist who can get an MRI which can come back with findings such as a disc bulge. As demonstrated in the infographic above, it shows us that at least 37-96% of individuals can have this problem in their lower back, and up to 87% in their neck.
It is also reported that for men aged between 40 and 70 years old, up to 96% of individuals have shoulder abnormalities . Although these individuals can carry out their daily routine symptom free.
There are many findings on imaging from head to toe that are part of the normal ageing process and yet do not affect any part of our social or work life or our physical activity. What we don’t know is that we may have already been living with them for many years in our lives. This goes to show that even if we have an ‘abnormality’ within our body on imaging, it doesn’t necessarily mean that we are ‘injured’ or that our injuries are as bad as they present.

Image: Leedarrenh

Back First Aid !

You’ve hurt your back – what can you do!?! This blog should help to explain what is going on and how to help yourself. Everyone is different, if you see a physiotherapy at Bureta Physiotherapy we can help make an individualised program for you.

Central low back pain –what is it?
Low back pain is very normal; in fact 80% of the population will experience low back pain some time in their life. This often resolves within 3 months, sometimes with recurrent episodes. People often don’t know why it happens and get upset as it can be very irritating and painful, restricting normal everyday activities.

Due to the mechanical pressure our low back gets exposed to, it is the most common part of our spine to get injured.  Most low back pain is caused by overstretching of ligaments and other soft tissue structures around our spine. This is often due to poor posture over a period of time. This soft tissue ‘damage’ is often easily reversible if we address the prolonged poor postures.

What can you do?

  • Don’t panic!
  • Keep moving! It is really beneficial for your back to keep active with light activity
  • Try lying on your stomach, prop yourself up onto your elbows if you are able to do this or onto extended arms
  • If you are unable to do this then you can try the rest position with feet up on a chair (see photo below)
  • Heat and pain relief can help to relieve the pain but not the underlying cause
  • Try some extensions 10x hourly (see image)– the majority of the population respond to this movement for pain relief and to restore some mobility. If this spreads pain into your leg then stop these exercises
  • Avoid aggravating postures
    – try sitting in a hard chair with a straight back, such as a dining room table chair, instead of in an arm chair
    – you can try a lumbar roll (you can source one of these from any physio at Bureta) for sitting
  • Get in to see a physio at Bureta Physiotherapy to help address some of these aggravating postures to prevent this from re-occurring. The physio can also start you on some core strengthening exercise, often seen in pilates classes, to provide some stability to your spine.

rest90

The 90/90 position as a rest position

What is Rehabilitation

Have you ever wondered how exercise works? Watch this video!

This video shows mechanotherapy at work. Mechanotherapy is the science behind how exercise works and why your physiotherapist prescribes your particular exercises. When you put a controlled load through the body’s tissues, like a muscle contracting against resistance, this will cause the cells in that muscle to respond. The cells recognise that muscle is working against resistance and a cascade of reactions begin that eventually lead to muscle fibres increasing in size. How your physiotherapist manipulates the exercise will determine what sort of reaction the cells will have. For example, exercises to build muscle are different to exercises that encourage weight loss. A detailed understanding of how this works is required by your physiotherapist to get the outcome you desire. The physiotherapists at Bureta are well trained in rehabilitation and exercise prescription so are able to tailor a treatment plan specifically for each individual!