subjective signs of achilles tendinopathy
recent change in activity load: frequency, intensity, time, or type, surface, footwear
subjective signs of patella tendinopathy
localized pain (1 finger rule), pain may initially decrease (warm up phenomenon)
subjectiv esigns of gluteal tendinopathy
load related pain (proportional to load), increased pain the morning after (latent symptoms ~24 hours later)
functional loading test achilles
heel raise/hopping
functional loading test patellar
single leg squat / jumping
functional loading test gluteal
single leg stance
what are principles of rehab following acute tendon injury
1) relative rest (maintain health/fitness/function)
2) early mobilization (inner to outer range)
3) early strengthening (inner to outer range)
what is the tendinopathy continuum?
a reversible continuum from a healthy to a degenerative tendon - explains how a reactive tendon CAN be rehabed back to a normal tendon with appropriate rest and repair, however, if you don’t rest, you begin to enter tendon dysrepair which is a big barrier to returning to normal and avoiding degenerative tendonitis
tendon loading program (eccentrics) FITVP
F: 2 x day, 7 days a week, for 12 weeks
I: non-disabling pain
T: eccentrics
V: 3 sets of 15 reps, for 3 secs and a 3 min rest per set
P: once no pain, add load to non-disabling pain
importance of tendon loading programs (eccentrics)
significant difference in pain and function
how long does it take for tendons to have changes in musculature and tendon structure>
any change in tendon structure needs at least 12 weeks due to its poor blood supply - previous studies were look enough to show that structural changes do occur, they just take time
what was the outcome of the tendon loading program study (isotonics) using the pain monitoring model - one group had relative rest and the other did pain provoking exercise…
both groups did the same exercise program and NO significant difference in outcomes
therefore:
- maybe athletes don’t need to rest for effectiveness of rehab (they should monitor symptoms)
- for non-athletes ,you can choose to go into less pain/more conservative treatments for comfort
benefit of the tendon loading program study (isotonics) using the pain monitoring model?
significant different in pain and function for both groups
what does the pain monitoring model state?
0-2 safe zone
2-5 acceptable zone
5-10 high risk zone
- pain is allowed to reach 5 during activity, after activity, and morning after, but is not allowed to increase from week to week
what are the 4 phases of the tendon loading program?
Symptom Management
week 1-2 inner range
3x10 once a day
Recovery
week 2-5 outer range
3x15 once a day
Rebuilding
week 3-12 add load
3x15 2-3x a week
Return-to-Sport
month 3-6 add speed
3x15 2-3x a week
what exercises are designed to improve power by initiating rapid eccentric contractions followed immediately by rapid concentric contractions?
plyometrics - energy storage and release exercises!
the ______ a tendon is loaded, the _____ it becomes and the more elastic energy it store
faster, stiffer
why are plyometric exercises typically called energy storage and release exercises?
due to their use of stored elastic energy
what exercises are an important rehabilitation tool for preparing clients to safely resume activities requiring power?
plyometrics (energy storage and release)
what are the findings comparing eccentric and heavy slow resistance (HSR) trianing?
eccentric
- time consuming, could be a hard sell for clients, go to this if lacking equipment for HSR
HRS
- preferred method and takes less time
**no SD in pain or function for both
SD in structure for HSR
SD in participant satisfaction HSR
what does tendon adaptation depend on?
it signficantly depends on loading intensity >70% and NOT on contraction type
when were standardized mean differences in changes in tendon adaptation higher
with durations longer than 12 weeks
when could isometrics be good for tendon loading programs?
they have been shown to produce analgesic effects (less pain for a short time)
you may want to use isometrics when someone’s tendon is acute, irritable, or in pain
what’s an indication to start isometric loading?
more than minimal pain with isotonic exercise
