Tendon Rehab Hacks: How to Optimise Load, Range & Speed for Faster Recovery
Tendon rehabilitation is a complex process that requires a comprehensive and individualised approach.
Runners can commonly experience Achilles, patellar and hip tendon injuries.
The key takeaways from this guide are:
Pain management through activity modification and activation exercises is crucial in the initial stages of rehabilitation
Control-based exercises help to improve stability, body awareness and reduce compressive forces on the affected tendon.
Gradual loading, with careful monitoring of pain response, is essential for progressive strengthening and functional recovery.
Progression to more challenging and functional activities should be tailored to the client's specific goals and needs.
Loading in compressive positions should be introduced cautiously, as tolerated by the individual's pain levels.
Ongoing adjustments to the program, based on the client's progress and goals, are necessary for optimal outcomes.
A maintenance program should be implemented to sustain the gains achieved during rehabilitation and prevent future injuries.
Introduction
Tendon rehabilitation is the process of restoring the strength, flexibility, and function of tendons after an injury or condition that has impacted their health. Tendons are the dense, fibrous connective tissues that attach muscles to bones, allowing for movement and force transmission throughout the body.
Tendon injuries can occur due to overuse or repetitive strain and they often affect tendons in areas such as the hip (gluteus medius tendon), shoulder (rotator cuff), elbow (tennis elbow), knee (patellar tendon), and heel (Achilles tendon).
Tendon injuries are commonly known as tendonitis (itis - inflammation) however the correct term is known as tendinopathy (pathy - pathology of the tendon). We now know that inflammation occurs as a result of injury and is not the cause of the injury.
Proper rehabilitation is crucial for recovering from tendon injuries and preventing further re-injury. The rehabilitation process aims to reduce pain and localised inflammation, and gradually rebuild strength, elasticity and function in the affected tendon and surrounding muscles.
Neglecting proper rehabilitation can lead to a delayed recovery, high levels of pain, decreased mobility, and potentially chronic pain.
Reducing Pain Through Activity Modification
One of the primary goals in tendon rehabilitation is to alleviate pain and discomfort. Identifying and modifying activities that exacerbate your symptoms is crucial in this process. It's essential to pay attention to the movements or actions that trigger pain and adjust accordingly.
Temporarily avoiding or minimising activities that cause significant pain (4/10 if 10/10 is severe) can provide relief and create an environment conducive to recovery. This may involve making modifications to your daily routine, work tasks, or recreational activities.
For example, if certain movements or postures aggravate your condition, consider alternative ways to perform those tasks or temporarily limit their duration or intensity. Talk to a physiotherapist if you are unsure.
In addition to activity modification, incorporating activation exercises into your routine can be beneficial. These exercises aim to promote better muscle activation and control, which can help reduce stress on the affected tendon. Activation exercises often involve isometric contractions, proprioceptive training and exercise adjacent to the injured tendon.
By practicing activation exercises, you can improve muscle coordination, joint stability, and overall body awareness. This can translate into better movement patterns and reduced strain on the injured area during daily activities. Additionally, activation exercises can help prepare the body for more challenging exercises and activities as you progress through your rehabilitation.
Remember, pain is a signal, warning you that there is potential danger to your body. It's essential to listen to it and make necessary adjustments however understand that tolerable pain is fine. Reducing pain through activity modification and activation exercises can create a solid foundation for your tendon rehabilitation journey.
Gradual Loading and Pain Monitoring
Tendons are resilient connective tissues, but they can become irritated if subjected to excessive or sudden increases in load. For example competing in a pushup challenge and you have only done 3 sets of 10. Or running every day for 1 week after coming back from a restful holiday.
To promote healing and prevent further injury, it's crucial to gradually increase the loading on the affected tendon while closely monitoring your pain response over a 24-hour period.
The key to successful tendon rehabilitation is striking the right balance between challenging the tendon enough to stimulate adaptation and avoiding excessive strain that could exacerbate the condition. This delicate balance can be achieved by implementing a systematic approach to loading and carefully observing how your body responds.
Start by introducing low-intensity exercises or activities that target the affected tendon. Pay close attention to any pain or discomfort you experience during and immediately after the exercise. A mild, tolerable level of discomfort is generally acceptable(<4/10 pain), but sharp or intense pain should at first be avoided (>4/10 pain).
After completing the exercise, monitor your pain levels over the next 24 hours. If the pain remains manageable and does not significantly worsen, you can gradually increase the load or intensity of the exercise during subsequent sessions. However, if the pain becomes more severe or persists for an extended period, it may be necessary to reduce the load or modify the exercise to alleviate the strain on the tendon.
This process of gradual loading and pain monitoring should be repeated consistently, with adjustments made based on your individual response. It's important to be patient and avoid the temptation to progress too quickly, as this can lead to setbacks and potentially prolong the rehabilitation process.
By carefully managing the load and monitoring your pain response, you can create an environment that promotes tendon healing while minimising the risk of further injury or aggravation. This approach not only facilitates recovery but also helps you develop a better understanding of your body's capabilities and limitations, enabling you to make informed decisions about your rehabilitation journey.
Progressing to Functional Activities and Tasks
As your tendon rehabilitation progresses and your pain levels decrease, it's essential to transition from isolated exercises to more challenging and functional activities. This progression will help you regain strength, mobility, and confidence in performing everyday tasks and movements.
Initially, you may have focused on exercises that target specific muscle groups or movement patterns. However, as you build strength and improve your control, it's time to integrate these movements into more functional and dynamic activities.
The key to progressing to functional activities is to start slowly and gradually increase the difficulty and complexity. Begin with simple movements and gradually introduce more challenging variations, such as adding external resistance or incorporating unstable surfaces.
It's also essential to pay attention to your form and technique during these functional activities. Proper movement patterns and body mechanics are crucial to prevent further re-aggravation and ensure optimal progress.
Consider working with a qualified healthcare professional, such as a physiotherapist, to ensure you're performing the exercises correctly and progressing at an appropriate pace.
Remember, the goal of tendon rehabilitation is not only to reduce pain but also to restore full function and allow you to return to your desired activities or sports. By progressively challenging yourself with functional activities, you'll develop the strength, stability, and confidence necessary to achieve your rehabilitation goals.
Loading in Compressive Positions
As the tendon rehabilitation process progresses, it becomes crucial to introduce loading in compressive positions. Compressive loading refers to exercises or activities that place the affected tendon under a compressive force, which can help to strengthen and condition the tendon for more demanding tasks.
The importance of compressive loading lies in its ability to simulate real-life situations and prepare the tendon for the stresses it will encounter during functional movements. Many daily activities, such as squatting, lunging, and running, involve compressive forces on the tendons, and failure to properly condition the tendon for these loads can increase the risk of re-injury or setbacks.
When introducing compressive loading, it is essential to do so gradually and with careful monitoring of pain levels. Start with low-impact exercises that place minimal compressive stress on the tendon, such as half-squats or wall sits. As the tendon adapts and pain levels remain manageable, you can progress to more challenging exercises like full squats, lunges, and step-ups.
It is crucial to listen to the body's feedback and adjust the compressive loading accordingly. If pain levels increase significantly or persist for an extended period, it may be necessary to reduce the intensity or modify the exercises. Proper technique and form should also be emphasized to ensure that the compressive forces are applied correctly and safely.
Individualising the Program for Client Goals
Effective tendon rehabilitation requires a personalised approach, tailored to the specific goals and needs of each individual client. As progress is made through the initial stages of pain reduction, control exercises, and gradual loading, it becomes crucial to adjust the program's focus based on the client's desired outcomes.
For clients aiming to increase their overall load tolerance, the emphasis should shift towards progressively challenging exercises that safely push the boundaries of resistance and weight-bearing. This could involve incorporating heavier loads, higher repetitions, or more challenging variations of existing exercises.
Alternatively, if the primary goal is to improve range of motion, the program should prioritize exercises that gradually and safely increase joint mobility and flexibility. This may involve stretching routines, dynamic movements through a fuller range of motion, or exercises that encourage controlled end-range positioning.
For clients seeking to enhance movement speed or power, the focus should shift towards plyometric exercises, explosive movements, and drills that challenge the neuromuscular system to generate force rapidly. However, it is crucial to ensure proper technique and control before progressing to higher-velocity activities.
Regardless of the specific goal, it is essential to closely monitor the client's pain response and make adjustments as needed. Increases in load, range, or speed should be implemented gradually, with ample time for the body to adapt and recover. Regular reassessment and open communication with the client are key to ensuring a safe and effective progression.
By tailoring the program to the client's individual goals and continuously adapting based on their feedback and progress, the rehabilitation process can be optimised for successful outcomes and long-term tendon health.
Maintenance Program for Sustained Progress
Achieving your rehabilitation goals is a significant milestone, but maintaining the gains you've made is equally crucial. A well-designed maintenance program will help you sustain the improvements in load, range, and speed, ensuring that your hard work pays off in the long run.
The maintenance program should include a variety of exercises and activities that mimic the challenges you faced during the rehabilitation process. This will help you maintain the strength, flexibility, and control you've developed while also allowing you to continue progressing at a slower pace.
Consistency is key when it comes to a maintenance program. Establishing a regular routine and sticking to it will help you maintain the progress you've made and prevent backsliding. However, it's also important to listen to your body and adjust the program as needed. If you experience pain or discomfort, it may be necessary to modify or reduce the intensity of your activities until the issue resolves.
Remember, a maintenance program is not a one-size-fits-all solution. It should be tailored to your specific needs and goals, and should be regularly reviewed and adjusted as necessary. By working closely with your physiotherapist, you can develop a maintenance program that will help you maintain your hard-earned gains and continue living an active, healthy lifestyle.
Conclusion
Remember, tendon rehabilitation is a journey, and a comprehensive, individualised approach that addresses pain management, strength, stability, and functional progression is key to successful recovery and long-term maintenance of tendon health.
