Sports Med Tips

How do you “Armor” up for your Key Race? Rehab with Armor PT!

October 24th, 2022 by JoAnn Cranson

As I limped my way to my car for the 2nd time in 2022, having just completed a 5k, I knew I needed to seek the advice of a professional. A 5k should not hurt as much as this and require a 4-day recovery period. With my goal race being in August and the race season still early, I turned to Armor Physical Therapy where Scott Miller, PT and his team of sports performance rehabilitation specialists went to work on my injury.

One of the initial benefits of Armor is the ability to book an appointment without needing a referral from your primary care physician. I was allowed 10 visits over a 21-day period which allowed time for an initial assessment, manual therapy, and rehabilitation as we sought approval for continual therapy. With each sports performance rehabilitation treatment I have sought with Armor over the years, initial diagnosis has been a lack of glute activation. My injury this time around was no exception. My hamstring and low back muscles were doing all the work and the nerves between the glute and hamstring were angry.

The therapists at Armor quickly went to work to create a program that was customized to my specific condition, needs and goals. The program included manual therapy, stretching and strengthening exercises, and a home exercise program.

With each visit, therapists used manual therapy for a hands-on treatment to remediate body functions. The manual therapy (aka massage) was the best portion of each treatment.

Stretching and strengthening exercises to improve flexibility, boost joint range of motion, strengthen muscles, and most importantly get my glutes firing again. Here is a sampling of a few of the strengthening exercises.

Exercise 1 – “The warm-up” – Total gym, banded squats

Exercise 2 – “The balancing act” – Rocker board with kettlebell arm swings

Exercise 3 – “The sobriety test” – alternating step-ups with a liquid-filled PVC

Exercise 4 – “Burn booty burn” – single-leg stability ball airplanes. Front view

Exercise 4 – “Burn booty burn” – single-leg stability ball airplanes. Back view

*Note – Armor is not responsible for the content of my exercise descriptions! 😉

Dry Needling

Armor offers a wide variety of additional services in their sports performance rehabilitation: Dry Needling, Gait/running evaluations, custom foot orthotics, and AlterG Anti-Gravity Treadmill, just to name a few. For a full list of Armor’s treatment options, visit https://armorpt.com. As a part of my customized plan, I utilized the Dry Needling and the Orthotics. With dry needling, the needles are used to stimulate an area of muscles that have become stiff. The special needles can reach areas that other manual therapies cannot. After each treatment, I found I had improved flexibility and range of motion. As a side note, the dry needling and orthotics are not covered under insurance but can be paid for through an HSA account. I found the benefits of both services to be well worth any additional costs.

With my diligence in attending weekly in office sessions, as well as, continuing home exercises, Scott and his team at Armor Physical Therapy, had me running pain-free by my goal race in August.

Stressed out? Get Moving!

August 27th, 2019 by JoAnn Cranson

By JoAnn Cranson

I’m getting that overwhelming feeling and I can feel the chronic stress and anxiety flooding into my body. Then my brain feeds on the total lack of control I feel with the stress. All the self-talk that I do does not convince my brain to let go of it. Sometimes it just seems circumstances build up including the unexpected death of a loved one, separation/divorce, family problems, health issues, financial difficulties and job challenges to name a few.

2019 has been a rough year for me and I’m left with how can I handle this? It’s so easy to fall into a depression and lack of motivation when that is the last thing I should be doing!

It’s time to get up and do something. Even days I don’t “feel” like exercising, once I put the effort in I can’t believe how much better I feel. My mind is clearer, my brain has had a break from thinking and I feel accomplished.

I started to read about some research that has been done. I was surprised to learn from the American Psychological Association that 75% of people in the US feel stressed out. The other two big issues that are contributing factors are unhealthy eating and lack of sleep. This, in turn, leads to one in three having depression.

As if that isn’t enough, when we are stressed our body creates extra of the hormone cortisol, which causes us to store more abdominal fat over time. Another doctor stated that stress is associated with just about every chronic disease we know.

All my self talk of trying to get my brain to think of other things, looking for distractions, or take a relaxing bath, but nothing works as well as exercising.

In more of my reading there is so many bonuses to exercising for my overall health. It’s the natural medicine that fights against many challenges we face every day. Through regular exercise it helps build up a resistance to stress. Cardiovascular workouts help the heart pump more blood to the brain which in turn is feeding our brain cells. There are even some studies that show as we age brain cells die off but now they are showing that exercise leads to preserving and making new cells.

Make the time and effort to find a form of exercise that you can enjoy and aim for 1½ to 3 hours per week. Start out slow, do the best you can, form a routine. Exercise is not the cure all for stress and anxiety, but it’s a piece of the puzzle that is helping me deal with the challenges of life.

Be Nice to Your Nervous System

December 16th, 2018 by Kaitlyn Patterson

-By Kaitlyn Patterson, Team Athletic Mentors cyclist

I’ve been intrigued by the endocrine system and nervous system for quite a while and after the grand tour of the major medical fields over my second and now third year of medical school, they continue to be my favorites. They are dynamic and responsive, influencing our eating patterns, sleep, body composition, happiness and performance. The endocrine system works through pulses of hormones – growth hormones, stress hormones, insulin – all with different patterns but always dynamic. In fact, the hallmark of a dysfunctional endocrine system is a stagnant or non-responsive hormone. The nervous system is also constantly changing- toggling between different modes: the sympathetic, commonly referred to as “fight or flight” and parasympathetic or “rest and digest.” Similarly, there should be a cycle to this as well since either one isn’t meant to be always on. The nervous and endocrine system work together to make sure your physiology matches whatever situation you happen to be in. Quite impressive really.

Image: Wikimedia Commons

One of the themes I have been struck by during my clinical training is the number of medical problems associated with chronic stimulation of the sympathetic nervous system. Most of these are common chronic diseases- sleep apnea, COPD, congestive heart failure, type II diabetes. It is an appropriate response by the nervous system as it is answering to a real threat- be it a lack of adequate oxygen entering the lungs, episodes where breathing stops, or a heart not pumping adequately. However, the constant activation of the sympathetic nervous system eventually creates its own problems- including reduced sensitivity to hormones like insulin and even depression. A sustained stress response is actually one of the possible mechanisms of the high rate of depression after heart attacks or strokes.

As athletes, we depend on our sympathetic nervous system every time we jump on the bike, in the pool or lace up the running shoes. It helps orchestrate the physiological response to exercise to allow us to do physical feats, feel good doing it and induce health benefits. As long as the stressor is episodic and followed by a shift to parasympathetic (recovery) mode for a time, all is good. However, it can be all too easy to abuse the sympathetic nervous system. Whether it be becoming greedy about training volume or intensity, additional life stress, lack of sleep, or under-fueling, sometimes the balance can be tipped into spending too much time in “fight or flight” mode.

At first, this is not obvious and we can get away with asking a lot of our sympathetic nervous system and even feel good doing it. However, it is ultimately unsustainable and can create the same type of maladaptive changes as seen in chronic diseases discussed earlier. Although performance might not decline initially, the first signs can include waking up too early and not being able to fall back asleep, feeling irritable, hungry, or losing motivation to train. If it continues it essentially can create a state of nervous system exhaustion when performance is significantly impaired. This spectrum is often referred to as “overtraining syndrome” although it is still a poorly understood phenomenon.

I personally believe this process is what many people refer to as “burnout.” Burnout is a bit of a buzzword especially in medicine right now, but it is often used as an ambiguous term. However, it appears there are parallels between athletic and professional burnout and both consistent with a maladaptive stress response with a big factor being the constant sympathetic nervous system stimulation.

I am guilty of phases of nervous system abuse, but feel I have gotten better at both identifying and respecting it. One hurdle for me is admitting I’m tired (even if I don’t think I “deserve” to be) and actually resting in response. For me and probably many endurance athletes, resting can take more discipline than training and it can initially be difficult to trust that resting more can lead to going faster and feeling better. Although race results are not everything, still being able to perform well while training less provides positive reinforcement. This process requires constant attention and I think it is one of the biggest challenges of being an athlete and a future physician.

Although a constant vigilance for this phenomenon is important for athletes and people in high pressure careers such as medicine, this is an important awareness for everyone. Unfortunately, the society we live in does not necessarily have built in cycles of rest and recovery. I think everyone should be aware of the need for natural ebbs and flows and the importance of respecting and protecting our nervous systems, not just to be good athletes or professionals, but to be healthy, fulfilled people.

What Being a “Fat Adapted” Athlete Really Means

April 25th, 2017 by Kaitlyn Patterson

–By Erin Young

Of course we all want to burn that fat to be lean, but there are dozens of reasons that being a better butter burner will make you a better athlete. Ever have GI distress (bloating, vomiting, bonking, etc. ) three fourths through your marathon? Are you filling your pockets with gels and bars to go ride for a couple of hours?

Contrary to what most of us have learned, these pouches of sugar, called “Gu” or “gels”, are not necessary or even healthy for athletes.

“Efficiency” is usually thought of as doing something well with little amount of effort. In endurance sports nutrition, this boils down to being able to burn more fat and less carbohydrate for energy. Why would we want to do this? Because at any given time, most trained athletes are carrying about 1,500 – 2,000 calories of carbohydrates and 80,000-plus calories of fat. Yep, even speedy little Meb has that much fat in storage. The trick is teaching the body to love to run on fat and use it at higher intensities. This is done through metabolic efficiency training to build a stockpile of fat-burning enzymes- the “machinery” to make it work. Voilà – the ultrarunner, cyclist or triathlete, becomes much less dependent on consuming mass amounts of carbohydrates during the race and has reduced risk of GI distress.

Just how do you ignite this fat fire?

The single most important contributor to improve your ability to use fat as fuel is diet. A diet low in refined foods, specifically carbohydrates, moderate in protein and fiber as well as higher in fat is key to priming metabolic efficiency . Yep, fats! Not the artificial, industrially produced partially hydrogenated vegetable oils, like corn, safflower, sunflower, or canola. Not crisco or margarine. Those are examples of the “bad” when we speak of bad fats. You can safely enjoy the real fats. Fats, included in meats, avocado, ghee (oh so good for cooking!), macadamia nuts, etc. Add these delicious fats and proteins into your diet and you will be satiated enough to stop thinking about your next meal. Stay away from “low fat” products and read your labels. Carbohydrate translates to sugar. Even those “healthy” organic dressings and snacks have the bad stuff. Take Newman’s Own balsamic dressing… healthy, right? Look closely at the label Vegetable oil (soybean and/or canola oil). Stick to the real oils, like olive and avocado. The food industry has learned to trick those who want to be healthy. But athletes, fats and protein are your friend. The real fats. Yes, even animal fats.

Give your gut a break. Lengthy fasts are not necessary, but giving your gut a break and laying off the mid meal snacks can tell your metabolism to use the fuel we all have plenty of… fat! If you’re hungry before mealtime, choose a small nutrient dense snack that can get you to you the next meal. Some great small snacks that stop the growling are:

Boiled eggs
Macadamia nuts, walnuts, almonds, Brazil nuts
Celery with almond butter
Hard cheeses

Get enough sleep. Your body does a lot of work at rest. You aren’t digesting and the gut can rest. Getting sufficient sleep lets you stay in a fasted state where your body is using fat stores rather than carbohydrates from your last meal. Waking up without having to immediately get a meal is a good sign you are functioning on fat stores.

You can also train your body to use fat stores through training! Before we get fast, we have to lay the groundwork. Being a metabolically efficient athlete means we have the foundation of which speed is built upon. To find out where you are as a fat burner you will need the help of my friends at Athletic Mentors to perform a metabolic efficiency assessment. You can do this as a runner or cyclist, whichever area you want to become more efficient in. By doing this assessment you will learn what are the most fuel efficient heart rate zone for you. Athletic Mentors can teach you how to build your foundation and reach your full potential. They are currently offering group classes to teach you how to use your own data. They will teach you how to fuel and train for metabolic efficiency. The next Metabolic Efficiency Class will be held May 11th, at 6pm.

Zach Bitter, world record holder as the fastest 100 miler on a track, is known for his fat fueled success.

You are meant to burn fats. The average American diet has allowed us to become dependent on carbohydrates to get us through the day, our workouts and races. Take a day to learn about your metabolism, and what you can do to stay healthy and burn the fuel that your body was meant to use. Metabolic efficiency training can help you stabilize your blood sugars, give you steady energy, lose body fat and allow you to run faster at a lower heart rate. All great results, so think about incorporating ME training into your base training. All you really need to start your ME training once you get the test, is your running shoes, a heart rate monitor and your body fat.

If you have questions, or want to schedule a test check out the website at www.athleticmentors.com or contact erin@athleticmentors.com with any questions about metabolic efficiency testing.

Stretching Advice from an OAM Master

August 19th, 2015 by Team OAM NOW / Athletic Mentors

By Jonathan Morgan, Team OAM Now Cyclist

After 38 years of competition where I remained relatively unscathed, I unfortunately had a serious injury during the Noquemenon Ski Marathon last winter. I would have bet strongly that a serious injury requiring surgery would come as a result of a bike racing crash, but not Nordic skiing…a beautiful, enthralling sport where there is nothing to fall on but soft snow. Right? Unfortunately, I found a way to crash at a high speed, on some odd bumps, pitch both forward and back, and eventually do a sort of split that resulted in severed hamstring tendons…and a left leg that didn’t work in one direction. Fortunately, we have some great resources as athletes representing a group of Orthopedic surgeons, so after surgery I’ve recovered almost to 100% and I can rightfully claim to be a “master” in this area of sport.

Now the rest of the story, and the first key point: As we age, our muscles stay very strong even as Masters athletes…similar to a 20 year old’s muscles. However, our tendons age and stiffen. This combination of power and stiffness leads to an increased risk of injuries like torn ACLs and ruptured Achilles tendons, or crazy ones like a hamstring avulsion (separation from the bone) that can end our ability to do what we love. Fortunately, there are relatively easy solutions with a little extra attention that can prolong our careers and avoid these serious injuries.

Second key point: Stretching is critical. Warm muscles and tendons are part of the stretching process. Following surgery and recovery, I started spinning on a bike with little resistance, then moved on to PT in a sport specific clinic. Each session began with 15 minutes of sitting on a towel wrapped around a sack of special clay that had been heated – the heat was so intense after 5 minutes that I often needed to shift position or add a layer of towel to reduce the heat, but the result was a very warm thigh and glut muscle that were ready for warm-up and stretching. Stretching consisted of only about 10 minutes of specific actions, but the result of warm muscles, properly stretched, was an incredible feeling of looseness and power once effort or resistance was introduced.

Third key point: How do we replicate 15 minutes of heat on a muscle and 10 minutes of stretching followed by a warm-up period before starting training or a race? I wanted that “loose, relaxed” feeling from the heat and stretch and discovered a way that is likely available to many of us – heated car seats. The PT told me that one of the biggest instances of hamstring, Achilles, and ACL injuries results from those older athletes who sit all day in an office setting, jump in a car (more sitting), followed by arrival at a training ride or race where we jump immediately on the bike, skis, or run without any proper warm-up or stretching. Year round, if your vehicle is equipped with heated seats, I strongly recommend that you turn them on and sit on the heat for 10-15 minutes, especially if you are an older or “tighter” athlete. It sounds terrible, but even on a hot summer day, the heat on your hamstrings and leg muscles really doesn’t feel bad with a little wind or AC in the car. Upon arrival, a short stretching session followed by a brief spin on the bike or a walk before a run or ski, will significantly reduce the risk of an injury. This is a way to use a somewhat common feature on many cars to reduce injury. For those without seat heat, at least be aware that stretching and a slow warm-up before max effort can save you a lot of grief and a potentially career ending injury.

I have been blessed to be naturally flexible and stretched the morning before the injury AND was well warmed-up, but I did not apply any heat. Heat is an added layer of protection from injury, so use those seat heaters if you have them, not just after the race for the endomorphin laced drive home, but to assure you get that chance to drive home instead of to the emergency room. Please note that you can also purchase heat seaters that plug right into the car (cigarette lighter/adapter) and it just might be a great $30 to spend. Stay warm, stretch, and stay injury free. Happy riding, skiing, running….

Road Block: Coping with Injury

June 9th, 2015 by Team OAM NOW / Athletic Mentors

By Elaine Sheikh, Team OAM Now Triathlete

My time over winter break was spent training hard. I returned to school, excited to continue and prepare for my first “A” race of the year – USAT Collegiate Club Nationals in Clemson, South Carolina at the end of April. I was going to race the draft-legal sprint and the Olympic triathlon. However, only three days into the semester, I noticed a strange pinching sensation in my pelvis. As an athlete, I’m accustomed to shutting out physical discomfort. Disaster struck when I was out on a run and began to experience unbearable pain shooting through my pelvis with every footfall. By the time I hobbled back to my house, I couldn’t even lift my leg high enough to get in the shower.

In a panic, I called my massage therapist, Paul Raynes, from the Conscious Core. I wanted him to tell me it was probably just muscle, but as I described my pain, he expressed concern over a labral tear or a pelvic stress fracture. Both options were terrifying, so my next call was to Orthopedic Associates of Michigan (OAM). I knew that by going there, I could see an orthopedic specialist right away, and I could go in after hours, so I didn’t need to miss any classes. I had already been to OAM for a cartilage tear in my wrist, so I was confident that I would receive excellent care. I was seen immediately and the doctor identified what appeared to be a stress fracture on my radiographs. This diagnosis was later confirmed by MRI, and I was devastated to learn that it would be months before I could run again. Not only were the collegiate nationals out of the picture, but I didn’t even know if I would be able to race at all this season.

Naturally, I became distraught and struggled for months with emotional pain far greater than my physical pain. However, I learned several coping strategies that I think apply to many different circumstances in which your plans are altered by non-preventable circumstances.

1) Stay calm. The more you stress about your situation, the harder it is for your body to heal. If you allow yourself to become over-stressed, you will be unable to eat and sleep properly; both nutrition and rest are vital for healing. Also, adding stress to your body diverts its attention away from the healing process.
2) Confide in people. I was very lucky to be able to talk to my coach Mark Olson, my sports psychologist, and several triathlete friends who really understood what I was going through. Allowing myself to be vulnerable and talk to people about my anxiety really helped me stay emotionally stable.
3) Follow the rules. As hard as it was to take the time off of running, listening to my doctor and my coach allowed me to heal quickly and *hopefully* completely.
4) Don’t let yourself get stagnant. My devastating run was on a Thursday, and I was in too much pain to even walk without feeling nauseous for several days. However, I didn’t let myself wallow long – by Monday I was back in the pool. In the next several months, I swam and cycled harder than I have in my life and stayed in shape throughout injury. Instead of having several wasted months, I focused on becoming a better athlete in the other disciplines.
5) Set new goals. I was really disappointed about not being able to race tris the beginning of the season, but I decided to start competing in aquabike and road races. Having a new race goal kept me excited and motivated to continue training.
6) Stay involved in the sport. Sure, I cried a few times when I opened Strava and saw my friends laying down killer runs while I couldn’t even walk properly, but I still stayed involved in the sport. I continued to follow race results, volunteer at races, and hang out with my triathlete friends. That way, I kept the sport I love fresh and alive in my life.

Remember, the goal is always to return to competition as safely, and quickly, as possible after an injury. In order to do that, having a recovery plan that takes into account the emotional trials as well as the physical ones is crucial. That plan will allow you, and your body, to take the time needed to come back ready to compete strong.

The Bio-mechanics of the Foot

September 19th, 2014 by Team OAM NOW / Athletic Mentors

By Jeffery D Regan LPT RTR, Director of Physical Therapy OAM

No matter what type of sport you do, for most of us the foot and ankle play a major part in our ability to participate. Over the years, much has been made of buzz words like supination , pronation, inverter, everter, toe in, toe out, forefoot striker, heel striker etc.. Honestly, it’s a lot to take in, but I’m hopeful I can make some sense of not only the terms, but also the bio-mechanics of the foot, in this blog.

First, pronation in the foot is actually a combination movement. It involves both eversion of the heel (a position where the heel moves outward) and abduction of the forefoot (a position where the front part of the foot points outward or away from the body). This is actually an unlocking of the foot and ankle which allows the foot to become loose and the medial arch to drop. Pronation is actually a natural mechanism that the body uses to adjust to the surface you are walking or running on and acts as a way to absorb the shock of weight bearing . The problem with pronation occurs when there is too much of a good thing. Over the years of doing many runner evaluations, the amount of what I would call “normal” pronation is about 15 degrees measured at mid-stance of gait phase. The angle is measured in how the heel is positioned in relationship to the calf. Angles that are greater than 15 degrees start to place increased loads along the longitudinal arch, posterior tibial tendons, peroneal tendons, the joint of the big toe or hallux and the ligaments of tarsals and meta tarsals of the forefoot. If left unsupported, the athlete can start to have problems such as: plantar fasciitis, hallux valgus or bunions, re-occurring tendonitis of the posterior tibial, peroneal, and achillies tendons. The problem can also go as far as interfering with the alignment of the knee and the kneecap, as well as hips.

Shoe manufacturers try to slow down or help support the athlete with varying degrees of extra support built into a shoe, calling it a “motion control shoe.” These shoes have materials like deep heel seats, hardened plastic heel cups, built up medial arch support, and a harder material as the last or the bottom part of the shoe. All of these things are done to slow down or control the amount of heel eversion and the drop of the medial longitudinal arch. Studies show that a runner with a mid-stance of gait will place 3-5X body weight through the arch of the foot. In other words, for a 200 pound man that is up to 1000 pounds of force that your arch, soft tissues, ligaments/ tendons and muscles have to overcome. In the gait cycle, pronation occurs shortly after heel strike when the runner or walker rolls weight from the outside of the posterior portion of the heel to the inner portion of the heel, thus moving to a everted position and allowing pronation to occur. Therefore, the heel is the key… control the heel and you can control some pronation.
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Tendonitis and Tendonosis: Treatment Part 2

August 14th, 2014 by Team OAM NOW / Athletic Mentors

By Jeffery D Regan LPT RTR, Director of Physical Therapy OAM

In the last blog, we looked at the what’s behind tendonitis and tendonosis and began the a discussion on rehabilitation of these two issues. In this blog, we’ll be looking at tendonosis and how we rehab with this diagnosis.

Damaged Tendon

Rememeber, if “Tendinosis” is suspected, you will have had prior problems with tendonitis in this same area. At this point, the tendon has gone through changes where healthy tendon fibers, with both vascular and neural components, have been replaced with scar tissue fibers. These fibers are random in orientation and the tissue has no vascular or nervous make up. Therefore, the tendon has less tensile strength, no blood supply, and little feedback as to where it is in space or its tension. This is usually where complete rupture is a possibility. Rehab of a tendinosis problem will usually take months, so patience is important.

Tendinosis also has 3 phases of treatment

1. Protection Phase
2. Tendon Remodel Phase
3. Return to Sport Phase

Protection Phase: It’s what the name implies: Protect the tendon. Do this first by stopping activity. In this stage, we want to make changes to the tendon, so the initiation of low-load stretching 2-3x per day, low resistance exercise such as aqua jogging or stationary bike is recommended. Aggressive friction massage (as described in the previous blog) right from the start is also essential. The use of modalities such as ice, heat, ultrasound, Estim, laser, etc. has been shown to be of some help in localized vasodilation to the area. In theory, this can help restore a vascular component to the tendon. Other more aggressive techniques such as plasma injections, high frequency ultrasound, FAST surgery techniques are aimed at restoring a blood supply to the tendon to help it restore healthy fibers. Steroid injections with this phase, in my opinion, will have little long term help and may cause complete rupture by further weakening the tendon. The goal here is to observe pain free sessions during the actual exercise or stretching. It’s okay to have minor soreness that dissipates quickly after the activity. When you have zero pain, move to the next phase.

Tendon Remodel Phase: This is the rebuild phase. We allow the prescribed activities to begin rebuilding a healthy structure around the tendon. During this phase patients continue the above exercises, but add open and closed-chain, one plane, eccentric strengthening exercises while continuing the stretching routine. Initially, there may be some minor pain either during or after sessions, but this will resolve after a couple of weeks. Once pain has subsided, the phase moves on to a large number of repetitions every day i.e. 2-3 sets of 20 reps 3-5 x per day with low loads, progressing to body weight for lower extremity issues or half body weight or less for upper extremity issues. If the individual can get to the point of large volumes of repetitions with body weight and no pain, s/he can start to resume protected exercises such as light elliptical eventually progressing to jogging. At this time, we’ll also introduce concentric, eccentric, and isometric strengthening on machines or with free-weights (be careful, go easy at first). If this can be accomplished without pain, we’re ready for the next phase. Studies have shown it may take up to 100 days for collagen to remodel.

Return to Sport Phase: This is the same phase as with tendonitis. Continuation of the above exercises and stretching, along with initiation of one plane activities that are sport specific at 50%. We’ll slowly increase intensity and add multi-plane exercise. When pain free, we initiate a gradual return to practice, then to game play or full participation in sport.

Healthy Tendon

Be methodical and go slowly at this point, you have gone through a lot. Don’t rush to get back until your body is ready and your body will let you know. The goal here, through each stage, is to introduce activity without pain so that you may return to sport, and not return to treatment.

Hope this helps

Keep your Stick on the Ice

Jeff

Tendonitis and Tendonosis: Treatment Part 1

July 31st, 2014 by Team OAM NOW / Athletic Mentors

By Jeffery D Regan LPT RTR, Director of Physical Therapy OAM

In the last blog, we talked about definitions of tendonitis and tendinosis with the goal of, over the next two blogs, discussing how to rehab these two similar diagnoses. This blog will deal with the rehab of tendonitis. However, before we get to how to rehab, we need to know a little bit about what is going on at the cellular level with the tendon itself.

If you were to sustain a hit somewhere on your body with enough force, the point of impact would experience cell death and a micro-hemorrhage of torn capillaries. This trauma would then set up an inflammatory response in the body where vasodilation, clotting mechanisms, and white blood cells would be called upon to help the injured area. The problem is that this chemical chain of events doesn’t just “clean up” the injured area; unfortunately, it also eats/destroys the surrounding healthy tissue. So, if your injury is a small, one-time event, then it’s really no big deal, but, if it happens over and over again on a repetitive basis it becomes a real problem. The area begins to get inflamed; fibers from scar tissue cross bind to other healthy tissue and restrict freedom of motion. There is a loss of capillary beds in the tissue itself. Fluid from the inside of joint or tendon sheaths stops being produced and therefore, the sheaths lose their lubricating effect. Eventually, the healthy tissue is replaced with non-aligned, avascular tissue that has a reduced tensile strength. In other words re-injury and overuse of a joint experiencing tendonitis is likely to result in tendinosis; it’s the way the system is, unfortunately, designed.

Tendonitis has three phases
1. Acute Phase
2. Recovery/Rehab Phase 1
3. Rehab Phase 2/ Return to Sport

Acute Phase: Usually lasts one week or less (depending upon the mechanism of injury). This period is typically marked by the initial incident, such as a specific trauma or a bio-mechanical problem that has finally reached a maximum load. During the acute phase you need to combat the chemical reaction caused at the injured site. The use of ice, either packs or massage, is a good topical tool when applied to the region 3x per day. An ice massage (or ice water bucket) is should be applied to the area until numb for about 5-10 min. A thin towel may be placed between the ice bag and skin to increase comfort, but it will take longer to numb. All in all, ice helps reduce swelling and brings new blood to the area which helps keep scar tissue down and capillary vessels in the tissue viable. Other modalities such as heat, US and Estim have merit, but there is limited scientific evidence that they are highly effective. OTC non-Steroidal medicines are another good way in phase 1 to combat the chemical response of an injury. These must be used as directed and need to be continued over period of time to keep the concentration level in your blood stream to have any effect. If you use them “one and done” then they will have very little effect on the inflammatory cycle.

The next treatment is very low resistance exercise to keep the joint, above and below, the injury going and the surrounding muscles pumping. This should be done with low to no resistance. The last thing that I like to do is friction massage to the injured tendon. No matter what you do, scar tissue will form secondary to the inflammatory process and we need to align the fibers (which are usually random) with the longitudinal fibers of the tendon itself for tensile strength down the road. If we don’t, a weak point will form in the tendon and, when stressed again, it will more than likely fail meaning we will start again, from the beginning. Friction massage is a “dig and roll” motion at 90 degrees, perpendicular to the long axis of the tendon working from origin to the insertion on the muscle. Start out easy and gradually, over days, increase the pressure. 3-4 x per day x 5-10 min is enough. A recap of phase one is: Fix your cause. Ice. NSAIDS, if you are able. Low-load exercise. Friction massage.

Recovery/Rehab Phase 1: The second phase can be started based upon your symptoms. If pain and swelling are reduced, and you are able to accomplish low-level function without an increase in symptoms, then the acute phase is done. Keep in mind that just because you have started phase 1 of rehab doesn’t mean that you stop acute phase treatments. You need to continue to use those tools to combat flare ups. The key to phase 1 of rehab is the addition of open Kenetic chain exercises in eccentric fashion to isolate and load the involved tendon, but exercise must be pain free. Open Kenetic chain means that your feet and or hands are not attached to a solid non-moveable surface such as the floor. Eccentric means the negative part of the lift/ exercise lowering against gravity. These exercises allow isolation of the injured tendon/muscle, control the resistance applied, and focus it to the tendon itself. With this, we can build strength and endurance over the next two weeks (or as long as it takes to resume low-level activity without pain) by slowly adding resistance (weights) along with repetitions. The last thing I introduce is low-level stretching, along with all major muscle groups starting at 30 sec holds (no bouncing) repeating 2-3x and 2 time per day. The goal is to increase the intensity of the stretch each day, as long as only the stretch is felt and not pain. When the stretches and low-level activity are successful, you have graduated to phase 2 return-to-sport level. Remember, during phase 1 you may need to exercise the “other” muscles of your body so that it stays in good physical condition.

Phase 2/Return-to-sport: Characterized by the continuation of the above, while adding close chain exercises and one plane drills at 50% of game intensity. Close chain exercises are those where your feet or hands are on a solid surface. Examples of this are Lunges, squats, pushups. These types of exercises are functional in that they create multi-planar contractions at many different joint levels along with many different types of muscle involvement and speed. For example, an athlete with patellar tendonitis who has been doing low load, high repetition leg extensions in Phase one, is now pain free and wants to return to soccer might start phase 2 with 4 inch quick steps (close chain and one plane) for 20-30 seconds x 3 reps at 50 percent, line hops with same parameters working front to back, side to side and diagonals. Balance/ proprioception exercises should also be introduced at this time to focus on the patient’s ability to hold joint posture, muscle co-contraction and know where his/her body is in space. When the athlete is able to perform these, along with other harder exercises at a 100%, its time to start a gradual return to sport at 50-75% of his/ her ability.

Start to finish, the process could be as easy as a couple weeks to as hard as months. In the next blog, we’ll move on to treatment of tendinosis.

Till then, keep your stick on the ice

Jeff

Repetitive Use Injuries: Tendonitis and Tendonosis

June 19th, 2014 by Team OAM NOW / Athletic Mentors

By Jeffery D Regan LPT RTR Director of Rehab Services OAM

During the past 24 years of my experience in physical therapy, I have been fortunate to be involved in the education, training, and rehabilitation of many athletes from young to old, from amateur to professional. Orthopedic Associates of Michigan (OAM) and I are honored to be a part of this organization; we also look forward to reaching out through this blog to answer any questions you may have in regards to your specific sport and/or training. I’m a hockey, baseball, and running guy by trade, but if I don’t know an answer to your question, I have the resources and personnel to get it. Regardless of sport, one common ailment we see is repetitive use injuries in the form of: tendonitis or tendonosis.

Normal vs. Inflamed Tendon

The simple definition of tendonitis is an inflammation of a tendon caused by:

1. Doing too much too soon on a soft tissue structure that was not physically capable of handling the load placed upon it.
2. A bio-mechanical abnormality that improperly loads the tendon with force that is not in alignment with the fibers of the tendon itself.
3. A bio-mechanical abnormality where the tendon is being compressed between two or more boney structures.
4. A lack of range of motion leading to abnormal friction on a boney prominence. While there are sometimes other causes, these are the top reasons it manifests in athletes.

Tendonosis, on the other hand, Read the rest of this entry »