In this video, Anthony uses a model to illustrate and explain the varying stages of tendon injury. You will see how each stage is unique in both its presentation and required rehabilitation. Most importantly, you will see how loading the tendon is critical in all stages, as long as it is applied correctly, and that rest is rarely useful.

Transcript:

hi guys it’s Anthony from Grand Stand

00:02

and today we’re talking tendons we’re

00:04

gonna be talking about it how attendent

00:05

works normally what happens when a

00:07

tendon starts to break down and most

00:09

importantly how to fix a tendon which is

00:10

starting to break down so for today’s

00:19

talk we’re gonna be using this piece of

00:21

rope to demonstrate our tendon now our

00:23

tendon is just like this piece of rope

00:24

and that it’s made up of lots of little

00:26

fibers which are really well organized

00:27

and compacted to give us a whole lot of

00:29

strength in a tensile direction now like

00:32

this piece of rope a tendon does not

00:34

deal terribly well with rotation loads

00:36

nor does it deal well with loads where

00:38

it’s being bent particularly over a bone

00:40

or surface like that so a normal tendon

00:43

should look like this very very well

00:45

organized this next section of the model

00:47

represents a tendon after we’ve loaded

00:49

it like going for a run or after a game

00:51

of football and we can see that there

00:53

has been some damage occur to the tendon

00:55

now this is a good thing because this

00:57

damage is actually the stimulus for the

00:59

body to make the tendon stronger and

01:01

therefore able to deal with more loads

01:03

later in the future the most important

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thing is is that we need to give our

01:07

body the right environment to repair

01:09

this damage and the right environment is

01:11

adequate rest and good nutrition to make

01:14

sure that the damaged following a load

01:16

settles down quickly and we repair back

01:18

to a normal stronger tendon if her load

01:22

is too high or a rest period is too

01:25

short the body struggles to deal with

01:27

the damage that we saw in the previous

01:28

model as a result it clean creases the

01:31

fluid within the fibers to try to make

01:33

the tendon stiffer now you can see in

01:36

this tendon here which is your typical

01:37

10 swollen tendon we’ve got fluid

01:40

gathering through there and the fibers

01:42

are starting to become a little bit more

01:43

disorganized if we continue to further

01:47

push the tendon without giving it addict

01:49

arrest then we start to see

01:51

neovascularization and

01:53

neovascularization is just a really

01:55

fancy word to say blood vessels and

01:57

nerves infiltrating into the tendon

01:59

matrix now this is a problem because the

02:01

blood vessels and the nerves are

02:03

sensitive and when they’re compressed

02:05

under load they produce pain and some of

02:07

the tendon pain you’re getting is from

02:09

the direct pressure

02:10

these tissues in there if you’ve had

02:13

tendon pain for a while you may have had

02:15

an MRI or an ultrasound which

02:17

demonstrated a tear of the tendon and

02:19

the tear is exactly what it sounds like

02:21

where you have a breakdown of some of

02:23

the fibers of the tendon now importantly

02:25

this tendon is never going to repair

02:27

itself and the tear will always be

02:29

obvious on MRI or ultrasound but that’s

02:33

not to say it’s going to stop you

02:34

getting back to your activity so let’s

02:37

review those stages of the tendon one

02:39

more time this time focusing on what we

02:42

do to try to make the tendon better

02:44

remember in our normal fatigue load

02:47

giving the tendon adequate rest and

02:49

nutrition is enough to have mouth

02:51

attendant not only to recover but also

02:53

to improve to be a stronger tendon for

02:56

next time you exercise once we’ve

02:58

developed some swelling in the tendon

03:00

it’s really a sign the attendant is

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struggling to deal with the loads that

03:03

you’re placing on it now this time this

03:06

might be an appropriate time for

03:07

relative rest from the aggravating

03:09

exercise so if your tendon gets inflamed

03:11

after running giving yourself a short

03:14

break from running may be the best thing

03:15

for it

03:16

now importantly don’t stop exercising

03:19

all together in fact loading the tendon

03:22

up you know isometric exercises will

03:25

help to push the fluid out of the tendon

03:27

and return the tendon back to its normal

03:30

matrix if you’re one of these people

03:32

with this chronic degenerative tendon

03:34

you’ve got quite a lot of work to do to

03:36

restore the tendon back to normal this

03:39

tendon will not respond well with rest

03:41

and in fact rest will just make the

03:43

tendon weaker without changing the

03:45

nerves in the blood vessel which means

03:47

it’s even more unlikely for you to be

03:49

able to return to your exercise instead

03:52

what’s paramount is to start to load

03:55

this tendon and the loading does two

03:57

things

03:58

alright isometrically loading the tendon

04:00

you can desensitize the nerves and the

04:02

blood vessels to the compression whilst

04:04

also making the tendon stronger and more

04:07

able to deal with load but those of you

04:10

who’ve had a tear diagnosed on an MRO

04:12

and after Sarah keep in mind that that

04:14

tear is always going to be visible under

04:16

investigation that’s not to say you

04:19

can’t return to your

04:20

sighs but it does mean you need to load

04:22

the tendon appropriately to make the

04:24

remaining fibers strong enough to deal

04:26

with a normal load the aim of any good

04:30

tendon rehabilitation program is to

04:32

restore your tendon whether it best be

04:34

overworked swollen and inflamed

04:38

degenerative or torn back to a normal

04:41

tendon and this is absolutely achievable

04:43

with the right loading parameters

04:46

applied to it and avoiding rest the

04:50

other thing to keep in mind is that

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within any one tendon you may have any

04:54

number of different stages going on at

04:56

different portions of the tendon and

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that means it’s absolutely critical to

05:00

find the right load applied at the right

05:03

time with right recovery from able to

05:06

you to have a full recovery

05:07

I hope this model is giving you a little

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bit more of an understanding of what’s

05:11

happening with the new tendon but also

05:13

the importance of loading a tendon

05:15

now if you’ve got any questions about

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what’s the right type of load see your

05:18

attendant please give us a call at

05:20

grandstand

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