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

Keeping you safe on the slopes

With the snow season commencing the excitement can be as intense as the chill; but there should be some things to take into consideration before strapping on our boots and hitting the slopes. Snow sports have a high risk for serious injuries. Although most injuries are caused from unexpected and uncontrollable factors such as weather conditions, falls and collisions; these can be minimised with good preparation and safety practices.

Falls and collisions on the mountain can be traumatic and could be caused by many factors;

  • Fatigue
  • Lack of instruction
  • Using slopes unsuitable for skill level
  • Faulty or ill-fitting equipment
  • Altitude sickness
  • Dehydration
  • Being off pieste
  • Back country without knowledge and/or experience
  • Failure to observe warning/ safety signs

Here are the National Ski Areas Association Responsibility Code for Reducing Risk

  • Always stay in control
  • People ahead of you have the right of way
  • Stop in a safe place for you and others
  • Whenever starting downhill or merging, look uphill and yield
  • Use devices to help prevent runaway equipment
  • Observe signs and warnings, and keep off closed trails
  • Know how to use the lifts safely

 

Equipment Essentials

  • Wear a helmet- it can save your life!
  • Good quality goggles; essential for seeing the contouring of the ground especially in low light conditions

Recommended for beginners and those who spend significant time on the mountain

  • Knee pads
  • Elbow pads
  • Wrist guards

Vital tip! Make sure your equipment is serviced and personally fitted to your experience level, weight and height. This ensures the safety features will work as they are designed to.

 

Stay within your skill level .
Familiarise yourself with which colour slopes match with which difficulty to avoid being in a slope that is too difficult.

Before considering going off pieste ask yourself; do I have the knowledge and experience? Are the conditions safe? Am I sure where the section will end up? Do I have the knowledge and gear in case of an avalanche?

If the weather changes suddenly make sure to; keep close to the slope markers and look out for warning signs and abide by them.

Most importantly make sure you feel confident to stop and/or change direction safely and quickly in case of an emergency.

Additional tips:
Parents supervise your children ensuring they are hydrated and fed, skiing appropriate slopes for their skill level and that they are abiding by the ski code.

AVOID DRINKING ALCOHOL- this can cause loss of judgement/ balance and control which could lead to injuries to yourself and/or others.

 

How physiotherapy can help?
To enjoy the ski season to its full potential prevention of injuries is more effective than treatment. The stronger, fitter and more flexible you are, the less likely you are to injure yourself in an accident and this is how physiotherapy can help! Physiotherapy can provide you with an individualised exercise program to increase your body’s capacity to cope with the physical demands of snow sports.  The program can be tailored to your personal weaknesses /tightness whilst also taking into account any previous and/or current injuries; chronic or acute. We can take you through the appropriate warm up and cool down techniques / exercises/stretches targeting your individual needs. Furthermore we can give pointers on your technique designed for injury management and prevention. By addressing these factors we can help improve your performance on the slopes and reduce your risk of injuries.

Enjoy your time on the slopes !

Heading to the slopes to ski or snowboard? – you have got to read this first!

Ok so the last couple of days in the bay have been super cold for our standards

Winter is here and many people will head to the snow for a well earned break. While skiing/boarding comes naturally to some, others spend most of their time unsuccessfully negotiating the equipment and terrain. Whatever your level of experience, skiing/ boarding can be hazardous and contribute to injury. The physiotherapists in our practice can help. We can ensure that you are prepared for the slopes by minimising your injury risk through specific exercise programmes, fitness regimes, strengthening and warm up, stretching and cool down techniques.

To avoid injury this snow season, the physiotherapists in our practice recommend you:

Be fit to ski/snowboard

Begin to incorporate ski-specific exercises into your regular exercise routine at least eight weeks prior to your holiday. This will promote use of the muscles and joints required for skiing. Strengthen the muscles specific to snow sports (thighs, butts, core stabilisers and triceps) to reduce the risk of injury and increase your enjoyment and endurance on the slopes. We can outline ski-specific or board-specific exercises whilst prescribing a conditioning programme to improve your core stability and muscle strength. Ultimately, your performance on the slopes relies on your fitness, so talk to us about how to achieve an optimal fitness level. We have access to a number of gyms around Tauranga and can write you a ski or board specific program and you won’t be tied into a long term membership!! Talk to us about Bureta Physio’s corporate gym rates 

Look after your back

When travelling distances to reach the mountain, rest every two hours and stretch. See one of our physiotherapists for effective stretching advice, and if you have had problems with your back come into the clinic and pick up a Lumbar roll for the trip which means when you unfold yourself after the trip you are ready to go

Warm up, stretch and cool down

Before hitting the slopes, warm up like you would with any other sporting activity. Stretch your thigh, calf and arm muscles check out or blog on dynamic stretches. Start your day with easy runs to loosen up (make sure you also do this after each rest break.) Once you have finished skiing for the day, remembers to cool down. These activities will better prepare your body to avoid injury. We can show you warm up, stretching and cool down techniques.

Ski within your capabilities

Beginners should take advantage of a ski lesson and not succumb to the pressure of keeping up with experienced skiers. Don’t be afraid to rest when you find yourself getting tired. Fatigue can increase your injury risk. And remember, the more unfit you are, the more tired you will become. Injuries often happen on that last run of the day!

To avoid injury on the snowfields this winter, consult one of our physiotherapists on how to best prepare your body.

5 gardening tips to prevent injury

Summer is here, the garden is going crazy, and it’s time to get out there and sort it out. Carrying compost or watering cans or pushing heavy barrows around the garden can increase your risk of injury, particularly for older people.

Our physiotherapists can advise you how to avoid these injuries whilst gardening.

We often treat patients with wrist, shoulder and back pain attributed to carrying heavy items and lifting awkward loads. To avoid this, we recommend that you warm up before and after gardening by stretching. We can recommend the type of stretches that would be most appropriate.

For our older patients who are at greater injury risk, we recommend gardening earlier in the day when the weather is cool and bright. This will minimise the risk of evening falls caused by reduced vision.

To help we have some handy tips for you to use when gardening. For more comprehensive information on avoiding injury whilst gardening or undertaking other household activities see one of our physiotherapists.

Tip 1 Bend your knees

When lifting items, remember to bend your knees, not your back. Never twist your body when your back is bent. When lifting, keep your feet apart and one slightly in front of the other. If you are unsure, we can demonstrate these techniques for you.

Tip 2 Don’t overfill

Never overfill your bucket, barrow or watering can. Only carry as much weight as you know you can lift comfortably. If you are unsure, we can help suggest an appropriate weight for you.

Tip 3 Equalise your loads

Distribute the load equally on each side of the body by using two lighter containers rather than one heavy one.

Tip 4 Closeness is the key

Always carry buckets, containers or loads as close to your body as possible. Holding any weight away from your body increases the stress on your upper body and back.

Tip 5 Use your surroundings

Place a watering can on a stool or chair when filling it, so you don’t have to lift it up as far when it’s filled. Place garden pots and containers on a bench to avoid bending to plant them out or work on them.

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.