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Tendon Rehab

Are you someone that deals with pain behind your heel, around your knee cap, or at the top of your hamstring where it meets your glute? It can be a real pain in the ass when you are trying to stay active or train but as soon as you begin making progress your knee swells up and you can hardly walk. It doesn't have to be that way. Once you understand what is injured, what environment it needs to heal, and what stimulus will drive that healing process, you can resolve this issue permanently and train the way you want to. Let's talk tendons.

Tendons have a wonderful ability to heal that is often unappreciated by the health and fitness world. People do silly things that have no impact on healing rather than follow a proven system for resolving tendinitis. Luckily for you, there is a plethora of solid research to support the following guidelines for rehabilitating the quality of a tendon. It should be noted that this is in no way personalized medical advice. If you have pain near or in a tendon you should be evaluated by a medical practitioner. If you've already been evaluated by a medical practitioner and you aren't getting the help that you need, reach out to me and we will find you someone who can help.

Tendons-A brief discussion on what makes them special.

  • Tendons connect bone to muscle to bone. It is helpful to think that tendons connect bone to bone and have a muscle belly in the middle. More on that later.

  • Tendons are 80% collagen, a specific protein that is designed to absorb force. Collagen is found in dietary sources like the grizzle on meat. It is not found in plants. It can be transformed into gelatin and eaten as well.

  • Tendons are very stiff and have a small diameter near the bone. As they get closer to the muscle, they get wider and become less stiff.

  • What makes a tendon stiff, and therefore resistant to stretch, is the amount of "cross links" between the fibers of the tendon. See the picture below for a visual of a tendons structure.

It is these crosslinks that we are manipulating when we are addressing an injured tendon. You see, tendinitis mean tendon swelling [tendon - itis (swelling)]. Swelling is not a bad thing in most cases. Swelling is a collection of fluid that has everything the tendon needs in order to heal the tendon back to normal quality. However, swelling can't always do it's job. When the tendon is too stiff, the pressure from the swelling isn't enough to penetrate the tendon and lay down new collagen that is floating around in the swelling fluid. So what do we do?

Step One

We optimize the environment the tendon needs to heal. That means we load up on collagen and vitamin C ~1 hour before step two. Vitamin C helps the body take collagen from the swelling and lay it down on the tendon. Imagine someone is laying brick for a new sidewalk. If we walk each brick down the sidewalk from the brick truck it will take forever. Chances are it will rain and the unfinished sidewalk will get damaged before it's finished. So, we take a wheel barrow (Vitamin C) and bring a bunch of bricks down the sidewalk at a time. Once the sidewalk is complete, there are fewer places the water can break through and damage the side walk. Therefore, Vitamin C and collagen are needed in abundance to provide an environment that is optimized for swelling.

  • Supplement collagen and Vitamin C one hour before step two.

Step Two

Now we need to encourage the tendon to want to heal. Tendons absorb force. That is what your body uses them for. The muscle pulls and the tendon absorbs the force and transfers it to the bone. We need to load the tendon to encourage the tendon to want to remodel and do its job better. One more time, WE NEED TO LOAD THE TENDON. We don't need to scrape the tendon, we don't need to cup the tendon, we don't need to massage the tendon, and we certainly don't need to release anything anywhere near the tendon. We need to load it in a manner that doesn't increase the damage to the tendon while the body does what bodies do, heal. We start loading with a 30s plus isometric (not moving) contraction of the muscle. We do this for two reasons.

First reason is the tendon needs to know it has a job to do. Second reason is we need to break up cross links and allow for the collagen to get into the tendon to repair the injured areas. There is a very interesting thing that happens when you squeeze a muscle that's attached to a tendon for 30s plus. The tendon begins to relax while the muscle doesn't. Part of tendon relaxes but part of it remains stiff. If you imagine that a tendon looks like spaghetti trapped in a rubber band, some spaghetti falls back through the bundle while some remains in place. This causes the cross links between the spaghetti to break and the tendon slowly loses its stiffness. This happens most dramatically near the muscle, rather than near to bone. This allows the collagen rich fluid to flood the injured area of the tendon and begin repairing.

  • Load the tendon appropriately

Now in order to not just break down every time it rains, we need the sidewalk to be as strong as the rain that hits it. The rain is your muscles contracting, the sidewalk is your tendons again. After we have gotten the healing process optimized, we need to strengthen the tendon back to full capacity. Strengthening isn't just a way to keep you on a plan of care an extra four weeks. Strengthening is the difference between it feels better and it is better. The strengthening program that a tendon requires is heavily body part specific and different depending on the pre-injury level of the individual and the goals for post rehabilitation. It would be impossible to cover everyone in this article so we will wrap it up here. Let's recap.

Tendons heal. Tendons need fuel for healing and stimulus to drive it. Just like a baby and the airplane. Fill up your spoon with collagen and vitamin C then load up your tendons safely.

If you have questions regarding the tendon rehabilitation process, reach out to me via email, I would be happy to help you.


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