Over use issues suck. And they suck more because a lot of the time they occur midway through things going good. You may be halfway through a training block, or you may have started a new activity or sport and are just getting into it. Then you get pain and a diagnosis of tendinopathy or maybe tendonitis.
But what is tendinopathy and Tendonitis? What
causes them and are then even a real injury?
Lets get into it and answer these questions.
Firstly lets define what an injury is.
The Cambridge English Dictionary defines an injury
as: "Physical harm or damage to someone’s body
caused by an accident or attack".
There are obviously shades of grey regarding this but at its heart is that physical damage has occurred.
Tendonitis fits into this category as real tendonitis is the physical inflammation of tendons. Tendopathy on the other hand is a general term used to describe pain of an area that cannot be explained. A common misconception is that all pain is caused by an injury. This is false.
The medical profession likes putting things in boxes, so when you present with pain on the outside of the hip you may get diagnosed with gluteal tendinopathy. Or you may have been told you have hip flexor tendinopathy. It may be reassuring to be given such diagnoses, but what use are they if we don’t know or look for WHY they occurred? These aren’t real medical diagnoses; they simply mean you have pain in your glutes or hips or inflammation in an tendon and we don’t know why, other than maybe it's because you like to run.
Both tendonitis and tendinopathy are generally classed as “overuse” injuries because they occur in individuals who have a high volume of training (but not always). Long distance runners are classic examples of the type of people likely to be diagnosed with either of these. And genuine overuse is sometimes a valid reason for either inflammation in tendonitis and undiagnosed pain in tendinopathy. But these genuine overuse reasons occur very occasionally.
The standard approach to viewing these sorts of diagnosis is that these areas are weak and you need to do rehab exercises to “even” out a muscular imbalance that caused the injury/pain to occur. In my opinion, this approach is half right in that things weren’t working as efficiently as normal. If everything was working fine there wouldn’t be pain. But just because a group of muscles isn’t working as well as they should does not mean that they are inherently weak and need “strengthening”.
Conventional methods of rehab confuse inefficiency and weakness as the same thing or mutually occurring at the same time. But that is false, and here is why.
A movement can become inefficient because of weakness, that is true and a possibility. But a movement can also become inefficient because the brain feels the need to avoid or protect you from something it sees as dangerous. It is the latter that is the most likely scenario and rectifying that will in my experience bring about much swifter resolution to the problem.
For example, if some stretch information from a knee ligament is viewed by the brain as dangerous, it will want to avoid stretching it.
In response to this perceived danger your subconscious will change your movement, forcing you to avoid that part of your knee as much as possible; resulting in over working other areas. These “other” areas are classic hotspots for tendonitis and inflammation to occur as well as the pain associated with tendinopathy. They tend to be the areas that are either bearing the brunt of the work or are limited in their ability to move because the brain is avoiding something.
The efficiency of so many muscles up and down the chain change and this myriad of increases and decreases of muscular tone will have an effect on both physical performance AND whether you are likely to feel pain or not.
As you can see, things are much more complicated than “you have tendonitis - your muscles are weak - do this list of exercises.
So how do we treat these sorts of symptoms in clinic?
First off we go through an in depth gait and movement assessment to see how efficiently you are moving. This is the best place to start as your subconscious controls how well you can move.
Then we look to identify areas/movements/muscles that are not working as efficiently as they should. Then, through the neurological techniques at our disposal we found out WHY muscular imbalance or pain occurred and help the brain to desensitise from these areas of perceived danger. When we manage that, normal movement will resume and the reasons for the pain or inflammation will no longer be there.
If you are dealing with genuine inflammation and tendonitis we will use other methods like cold laser (photobiomodulation) therapy to help speed up the process of healing and reduction in inflammation.
We will also discuss lifestyle factors, diet and supplements that will be useful to aid bringing the level of inflammation down.
All of this occurs in the first few stages of our four part treatment process and is why we believe that searching for the root cause(s) for pain or inflammation is far superior to massaging a painful area of attempting exercises to strengthen a “weak” muscle.
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