Myths about tendons

As a Sports Therapist it is vital to keep up to date with the latest research and thanks to technology and the development of blogs and webinars it has become a lot easier to find out what is being studied and the results.

One blog I follow is by Dr Peter Malliaras (Tendinopathy Rehabilitation). I was lucky to go on one of his courses a few years ago but even now things are moving on. His latest post was updating his own most popular blog post 9 tendinopathy truths that you MUST know.

In short for those suffering with Tendonipathy, here are the truths

1) Tendinopathy does not improve with rest

2) Tendinopathy is not considered to have a classic inflammatory response, no need for anti-inflammatories.

3) Tendinopathy can be caused by many different risk factors, not just related to activity changes.

4) Exercise is the most evidence based treatment for Tendinopathy.

5) Modifying load is important in settling tendon pain.

6) Pathology on imaging is NOT equal to pain

7) Tendinopathy rarely improves long term with passive treatments such as massage, therapeutic ultrasound, injections, shock wave therapy etc.

8) Exercise needs to be individualised.

9) Tendinopathy responds slowly to exercise. You have to have patience.

Conclusion

There are no short cuts is recovering from Tendinopath, exercises have to be adjusted to pain and function and progressive loading applied to enable restoration. Seeking out a therapist to discuss and talk through your Tendinopathy is recommended. Usually only a few appointments are needed to explain and advance the rehabilitation process with continued minimal contact with the therapist to monitor and discuss progress (mainly via phone, email)

If you are a clinician for more in depth information on Tendinopathy I recommend you check out Tendinopathy Rehabilitation

 

Back pain breaking the myths

Back pain is the most common area of pain I treat in the clinic. Everybody at some point will have an episode of back pain and for those unlucky few ongoing recurrent problems.

The approach to back pain has changed a lot and challenges many widespread beliefs about the condition. Here is what I have found out throughout my 10yrs of experience.

1. Back pain is common and normal.

Most back pain is due to strains and sprains and usually resolves within 6 weeks. Only a very small percentage go on to develop long standing disabling problems and many of these may improve with the right help.

2. Scans are rarely needed. You would think that a picture of the spine would explain why you are in pain but it is not that simple. The scans will often show up things that are poorly linked with pain. Many people who have no pain are shown to have bulging discs, degenerated discs, arthritic changes etc. If you are told you have these problems it can lead to further distress and avoidance of activity.

3. Back pain is not caused by something being out of place. Many people may feel better after manipulations/mobilisations but this is mainly down to short term reduction of pain, muscle tone/tension and fear. As therapists we use these techniques to help get you moving better not to realign you.

4. Bed rest is not helpful. This can create stiffness, muscle de-conditioning and fear. Stiffness itself is painful and treatment and exercises will be painful to get movement back again.

5. Increased back pain does not mean more damage.

6. Surgery is rarely needed. Many people who have back surgery still have pain after because they have not taken a multi factoral approach to getting better. No one treatment will work on its own.

7. There is no perfect sitting posture. It is about moving and altering posture instead of maintaining posture that is important. The body will never like being stuck in one position for any length of time.

8. Lifting and bending are safe. Yes it may cause a strain in the back but should never be avoided as it is good strength work for the back and body. And yes there are bad techniques that can lead to injury, just remember you have a pair of legs to help you. Don’t lift silly amounts of weight, be smart. The length of the activity also has an influence break it up into smaller manageable amounts.

9. Avoiding painful activities is not the way forward. Fear of pain can heighten your senses of back pain and increase stress on the back due to an altered movement pattern.

10. Poor sleep, stress, low mood and worry all influence the back.

11. Exercise is good and safe and persistent back pain CAN get better with it.

Long standing back pain has to have a whole body and psychological approach. Manual therapy can help but exercise is very important as well. So is general health, looking after you weight, healthy diet, good sleeping pattern and knowing how to cope with stress. Everyone is different so what works for one person will not work for the next.

 

 

 

Should you exercise through pain?

As a Sports Therapist this is a common question I get asked.

‘Should I exercise through pain?’

First of all if you have persistent pain whilst exercising, please get it checked out.

My response  to this question is usually ‘it depends, pain is complex’ clients are left frustrated by me leaving the answer open ended. It is important for the client to understand pain but it can take time to explain. I tend to stick to 3 short rules.

  • During your session use a pain scale 1-10 (1 no pain 10 pain as bad as it could be) do not go into or beyond 6/10.

0-2 Safe 2-5 Acceptable 5-10 high risk

  • Recovery, if you have 3/10 pain the next morning that is okay you can do your next session, if you have 3/10 pain in 1-2 days you can do your next session with caution reduce intensity or volume, if you still have pain above 3/10 3-5 days after, then you have done too much, rest, and cross train. Your next session should involve less volume or less intensity when pain has reduced to an acceptable level.
  • If you have to miss 2 weeks of exercise or pain is not reducing in fact is getting worse: rest, cross train and seek out an injury expert.

The above maybe all you want to know but here is some more in depth information:

Pain is a complex thing, I have done a lot of reading on it and here are my conclusions. It can really stop us in our tracks or it can just let us know we had a good training session. Peoples perception of pain varies greatly, what is sharp for one person may just be dull for another. Our bodies response to a pain stimulus is also not very accurate, using an example of making toast, it can not tell whether you have burnt the toast or burnt the whole house down. It just sends the signal and sometimes, over reacts. We can say pain and tissue damage are very poorly correlated. Just because you feel pain does not necessarily mean you have damaged something. An example would be a single episode of cramp.

Can you change your pain?

See if slowing down, reducing intensity, and/or changing type of exercise (high impact to low impact) eases your pain. Are there certain movements which ease your pain, performing these regularly but staying away from painful actions can off load the injury site and help it recover. Sometimes a change of footwear is needed. If trainers are getting old or have started to lose their support due to getting soaked through it can trigger many lower limb injuries. Check for technical errors or if you have implemented some changes intensity/volume/technique/equipment have these triggered the pain?

Sometimes when you can modify your pain it is good to test your limits. I have seen many clients where actual fear of injury recurrence can increase perception of pain. Test it out gradually on your next sessions, do not go straight back into the same volume or intensity, build it back up. Your injury site has to get back to a level of been able to cope with the impact, fitness and stress of your exercise. Exercise in itself can help stimulate healing. An injury specialist can help guide you, to help get you back fully into your chosen exercise.

Physiologically what signs can we see of a serious injury?

Look for swelling, redness, heat, severe pain, giving way or locking of a joint and bony tenderness. You should not exercise through pins and needles or numbness, which are your typical symptoms of referred pain from a disc/nerve been compromised. All of the above are symptoms you should not exercise through. These are symptoms to get checked out.

When should I definitely NOT exercise?

If there is any suggestion of a stress fracture, then exercise especially impact exercise (running, zumba, gymnastics ect.) should be avoided until advised it is safe to do so. You may be able to use swimming or cycling for very light exercise but only if they give the go ahead. Acute injuries or the acute stage of an injury (1-2 wks) active rest is recommended. If a tendon has become swollen and very painful (reactive) exercise will likely aggravate it further. If a tendon injury has been around for a while and you mainly get pain after or the next day but it goes away in a few days, exercise is okay. If you have been training really hard, you may have over trained and rest can be the best option for both recovery and injury. Do not push through chest pain or abdominal pain.

Try to follow the above information if you are having pain exercising and if ever in doubt get it checked out. Never put up with pain thinking it will go away, it may just get worse.

 The text above is for guidance purposes only. If you are in pain whilst exercising then seek out a specialist in this area.

Neck and Shoulders Feeling Tight?

Neck and shoulder pain? tight or painful chest? stressed at work or home? does your pain keep returning or getting worse? Breathing patterns can contribute to or even be the cause of your chronic muscular pain. Here is some information you will find helpful to start finding relief.

Breathing is intertwined with our bodies emotional responses and stress levels, how? the diaphragm’s connection to the brain. We have to breath to survive, we do not have to think about breathing it just happens but it can also be controlled.

How does breathing relate to painful shoulders? when we are stressed our brain sends an alarm signal that alerts us to danger. however this works like a fire alarm. It does not know whether you have burnt your toast or if the house is on fire. It simply sends an alarm.

Your reaction to this alarm has 3 reactions Fight, Flight or Freeze. Within the work environment you can not start a fight or run a way from it unless you want to lose your job. You just hope that the deadlines and work volume will somehow go away without devouring you? This is the freeze response and is usually accompanied with breath holding. Breath holding is a natural primitive survival instinct and is an automatic response to stress and pain.  It is something we do not usually notice ourselves doing unless we are extremely body aware.

When we freeze our breathing becomes shallow, our ribs move less and our muscles become tense. If we were in a real life threatening situation we would be playing dead. With this response repeated day after day it can lead to our muscles feeling stiff and hard, leading to chronic pain and dysfunction.

If not acknowledged and dealt with stress can cause many health problems, sore muscles are just the first step. It can lead to you feeling tired and run down, frequently getting ill and headaches. All warning signs that your body needs some kindly attention.

So what can you do?

You begin your journey by having awareness of your breath. It is advised that you do seek out a therapist to make sure you do not have any underlying mechanical reasons for your neck and shoulder pain. Breath holding maybe in response to protecting an injury site.

Muscular pain caused by work related stress is very treatable. With the assistance of a therapist you can become more aware of your breathing pattern and put ‘you’ in driving seat to combating your pain.

Here at Pro-Am we can help you to understand the mechanisms of the stress response and help improve your breathing pattern which will help keep your shoulders, ribs and chest mobilised.