THINGS YOU MAY NOT KNOW ABOUT TENDON PAIN
by Karl Kolbeck, PT, OCS, SCS, FAAOMPT
It’s likely we’ve all experienced tendon pain at some point. That painful shoulder after a long day doing yard work or throwing a ball: rotator cuff tendon(s). The pain at the back of your heel after an ambitious hike or jumping rope too long the first time back at it: Achilles tendon. Pain on the outside of your elbow after using power or garden tools all day: Fibroangiomatosis Hyperplasia of the Extensor Carpi Radialis Brevis (haha…had to throw that in here)…aka Common extensor tendon pain…aka ‘Tennis elbow’. Which many of you have heard of but doesn’t occur by only playing tennis. Tendon pain is common and often is low grade and resolves on its own in a matter of a few days. However, it can also become progressively worse and interfere with daily activity, work, or play. It can hurt and be debilitating. With progressive tendon pain comes the degradation of the tendon tissue. Studies have shown that the degraded tendon tissue does not heal. But don’t fret. With proper physical therapy, recovery from tendon injury proves successful in most cases and injections or surgery are often avoided.
Feel free to contact our highly trained physical therapist at Rose City Physical Therapy.
So if degraded tendon tissue from injury doesn’t heal, where does the success in recovery come from? By building new healthy tendon tissue around the weak link. The analogy we use is a donut. The hole in the donut is the degenerated (damaged) area. The surrounding donut is the healthy tendon structure. Evidence supports that with proper load (exercise progression), tendon cells (called ‘tenocytes’) are stimulated and form new healthy tendon structure around the damaged tendon. This new robust tendon provides support and integrity to overcome the weak link at the damaged area.
Key is proper load progression. In the past 6 years or so there is a strong body of evidence that has created a shift in tendon rehabilitation. Some of you who’ve had treatment for tendon injury in the past have likely been put on an ‘eccentric’ exercise routine, with a twice-a-day prescription of 3 sets of 15 repetitions of two exercises that emphases only the descent (eccentric) phase of an exercise . Unfortunately, we see a lot of patients with chronic tendon pain that are not progressing with their treatment elsewhere and seek care with us, and this protocol remains commonly what they have been doing. Frankly, it’s too frequent (twice a day loaded exercise…ouch!) and not heavy enough load. And time consuming…a total of 1260 repetitions that takes approximately 308 minutes per week to complete.
Out with the old, and in with the new…enter the ‘Heavy Slow Resistance Training’ (HSRT) program.
Our trained physical therapists are dedicated toward helping you achieve a pain-free life.
A strong body of evidence now supports that less frequent but heavy-load low repetition exercise proves much more effective in overcoming tendon pain and getting people back to function. A two-times-a-week exercise routine of 3 sets of slowly executed exercises is what current best evidence suggests and is referred to as a ‘Heavy Slow Resistance Training’ program. It consists of slow execution (3 second rise, pause, 3 second descent) of heavier load‒hence low repetitions (eight to 10 reps)‒and is only completed twice per week with 2 exercises. A total of approximately 120 repetitions that only takes about 36 minutes of your time per week.
In addition to focused specific exercise prescription, at Rose City Physical Therapy we also offer Low-Level Light Therapy (Cold Laser Therapy) for tendon management. This modality has some of the strongest evidence to support its efficacy for acute tendon pain management and to stimulate healing at the cellular level.
Give us a call if you are dealing with known or suspected tendon pain …tendinitis, tendinosis, tendinopathy‒you may have been told you have one of these common three descriptions. Chronic tendon pain that is not managed appropriately only gets worse. Conservate physical therapy can help and is your first line of defense.
We offer a 20-minute complimentary screening to discuss your problem, screen the problem area and discuss what successful treatment would include. Email reception@rosecitypt.com with ‘Free Pain Screening’ in the subject line, or call today to set up an appointment.
Karl Kolbeck, PT
Karl has been practicing orthopedic and sports physical therapy for 29 years, with his experience focused on shoulder rehabilitation and the injured runner. Two areas that commonly experience tendon pain. He has taught shoulder rehab nationally for 15 years. Karl is board-certified in both orthopedic and sports specialties. His practice is closed to new patients as his primary role is staff education and mentorship to create excellence in care by all physical therapists at Rose City Physical Therapy. Contact Us!