The Tendonitis Cure

 

Fix Your Elbow, Knee, and Achilles Pain

by Joel Sanders | 01/06/16

 https://www.t-nation.com/training/tendonitis-cure?utm_source=facebook&utm_medium=social&utm_campaign=article4279

It happens to almost every athlete and dedicated lifter: tendonitis. And when it really starts hurting, everyone tries to fix it with the same methods: time off, form adjustment, a few extra stretches, massage. But when it becomes impossible to open a jar without pain, these things just won't cut it. Here's what really works.

Disease of the Tendon

People think tendinitis is solely inflammation of the tendon. Research over the last 20 years has shown that while the tendon is inflamed, it's also partially broken down and degraded.

This is why it's often referred to as tendinosis – "osis" meaning degradation of the tendon, instead of "itis" which just means inflammation. The term tendinopathy combines both to mean "disease of the tendon." No matter what you want to call it, pain can crop up on any tendon in the body but is most often found in an Achilles, patellar, elbow, and shoulder.

Old School Treatment

"Rest it. Ice it. Maybe some massage or a TENS unit. Still have pain a month later? Go get a cortisone shot. Cortisone relieves the pain." But four months later the pain slowly creeps back and it's time to start therapy again. This approach doesn't work because it only addresses inflammation of the tendon. Rest, ice, and cortisone are all anti-inflammatories. While they help reduce pain, there's still a tendon that's broken down and needs to be remodeled and strengthened.

And don't use aspirin. You need to increase blood flow and short term inflammation. Inflammation plays an important role in the healing process. So anti-inflammatories will stall healing.

Think of a tendon with tendinopathy like a building with a crack in the foundation. You wouldn't say, "Let's just not live in the building for a while. The crack will get better." No, the crack must be repaired. Staying away from it does nothing. When it's time to move fast, sprint, or lift heavy things, the tendon simply can't transfer the forces without getting pissed off again. Tendons must be remodeled, stabilized, and strengthened.

Make the Tendon Heal: 2 Methods

1 – Cell Stimulation

Cell stimulation techniques remind your brain that your tendon is there and it needs extra attention. There are countless methods that get the job done, but we'll focus on two methods that are inexpensive and accessible.

VooDoo Flossing:  Imagine breaking a bundle of raw spaghetti noodles in half and throwing them in a bowl. They'll haystack and crisscross everywhere. Layers of fascia and tissue around a joint can get mucked up in this fashion, especially when an injury is present.

Wrapping a VooDoo band and applying tight compression around an injured joint or tendon while going through basic movements can facilitate more sliding, gliding, and realigning of your spaghetti noodles. And according to physical therapist, Kelly Starrett, after spending a couple of minutes with blood flow restricted to the wrapped area, a rush of blood will pour back to what can be a poorly saturated joint and tendon after you take it off.

Gua Sha:  Don't let the name fool you. You don't need to travel to a remote village in China in search of a medicine man. Go buy a $10 Gua Sha tool online along with a canister of coco butter and you're set. Gua Sha is another convenient tool to increase blood flow and stimulate cell activity in a tendon. (Videos below.)

2 – Strength and Slow Tempos

It always comes back to strength! Noted tendon researcher Jill Cook says, "Adding or removing load is the primary stimulus that drives the tendon forward or back along the continuum."

Too much load or too much speed is one way the tendon got broken down. To repair it you must start with SLOW tempo exercises. One of the main jobs of a tendon is to function as a spring. Strength work with eccentrics (negatives) and slow tempo is a way to rebuild and prep the tendon for its springy actions. Numerous studies have shown that eccentric-only protocols and heavy, slow concentric/eccentric protocols work.

Note: Pain Is Complicated

You've heard that pain is a sign of damage, but it's more complicated than that. Pain doesn't always equal harm. Feeling pain up to a 5 on a scale of 1-10 is okay during the strength exercises. Studies show that when researchers have patients push through pain, the tendon will supercompensate overnight. This increases healing. But if you have increased pain 24 hours later, then take note – that's a sign that you should back off a bit.

The Plan

Tendons are slow healers. It takes months, not weeks, to get them fully healed. But to really fix the problem, make this plan an everyday chore. View it like you would flossing your teeth. And yes, this plan requires a few tools you'll need to buy. When the pain is gone, you'll agree they're worth the cost.

1. A six week hypertrophy phase that focuses on eccentric protocols to be done every day.
2. A six week phase using heavy, slow resistance with a 303 tempo (3 seconds up, no time spent at the peak of contraction, 3 seconds down) with strength exercises to be done three times per week.

Both phases include Gua Sha and VooDoo flossing. Cut out the exercises that flair up your tendon during the first phase, then slowly integrate them back in during the second phase.

Fix Your Elbow Pain

Cell Stimulation:  Do this 3 times per week right before you do the recommended exercises in both phase 1 and phase 2 below.

Gua Sha for Medial & Lateral Elbow

VooDoo Flossing for Elbow Pain

Phase 1: Hypertrophy, Weeks 1-6

Exercise:  TheraBand FlexBar Eccentrics

Order a couple of these handy tools online with different resistance levels. Release hand from FlexBar and get a full stretch of the forearm each rep. During this time, remove high speed racquet or club sports as well as heavy pulling and gripping movements (pull-ups, rows, loaded carriers, hang cleans).

Medial Elbow

• Everyday do 3 sets x 15 reps
• Slow, 3 seconds eccentric
• 2 minutes rest between sets
• Add load by progressing through different resistances of FlexBar

Lateral Elbow

• Everyday do 3 sets x 15 reps
• Slow, 3 seconds eccentric
• 2 minutes rest between sets
• Add load by progressing through different resistances of FlexBar

Phase 2: Strength, Weeks 7-12

Continue cell stimulation techniques before these exercises. It would be fine to start practicing racquet or club sports and add in some pulling and grip work if pain is low (about a three on a scale of one to ten).

Exercise 1:  EZ Bar Curl
Exercise 2:  EZ Bar Reverse Curl

Week 7:  3 x 15 RM (as heavy as you can go for 15 reps)
Week 8-9:  3 x 10 RM
Week 10-11:  4 x 8 RM
Week 12:  4 x 6 RM

• 303 tempo (3 seconds up, 3 seconds down)
• 2 minutes rest between sets
• 3 times per week

Fix Your Achilles Pain

Cell Stimulation:  Do this 3 times a week before the recommended exercises. Remove sports and high speed movements that cause pain during this stage.

Gua Sha for Achilles

VooDoo Flossing

Phase 1: Hypertrophy, Weeks 1-6

Exercise:  Eccentric Calf Raise

• Press up with both legs, lower with leg that has pain.
• 3 sets x 15 reps
• 3 seconds lowering
• 2 minutes rest between sets
• Do it everyday
• Add weight via weight vest or calf raise machine as you progress

Phase 2: Strength, Weeks 7-12

Continue cell stimulation techniques before exercises. It would be fine to slowly add in low level plyo or running as long as pain is low.

Exercise 1:  Standing Calf Raise
Exercise 2:  Seated Calf Raise

Week 7:  3 x 15 RM
Week 8-9:  3 x 10 RM
Week 10-11:  4 x 8 RM
Week 12:  4 x 6 RM

• 303 tempo
• 2 minutes rest between sets
• 3 times per week

Fix Your Knee Pain

Cell Stimulation:  Choose either VooDoo flossing or Gua Sha and do every other day before the recommended exercises. Remove sports, high speed movements, and lunging/squatting with deep knee flexion during this stage.

Gua Sha for Patellar Tendon

Voodoo Flossing for Patellar Tendinopathy

Phase 1: Hypertrophy, Weeks 1-6

Exercise:  Eccentric Single Leg Squat – Heel Elevated

• Press up with both legs, lower with leg that has pain
• 3 sets x 15 reps
• 3 seconds lowering
• 2 minutes rest between sets
• Do it everyday
• Add weight using weight vest as you progress week to week

For this exercise, let the knee come as far forward over the toe as possible for greater tendon stimulation.

Phase 2: Strength, Weeks 7-12

Continue cell stimulation techniques before the recommended exercises. It's fine to slowly add in low level plyos or running as long as pain is minimal.

Exercise 1:  Back Squat
Exercise 2:  Leg Press

Week 7:  3 x 15 RM
Week 8-9:  3 x 10 RM
Week 10-11:  4 x 8 RM
Week 12:  4 x 6 RM

• 303 tempo
• 2 minutes rest between sets
• 3 times per week

Note:  Special thanks to Ashley Rice, ATC, presented in the Gua Sha videos.

Related:  The Two Minute Injury Fix

Related:  Do-It-Yourself Myofascial Release

References

1. J L Cook, C R Purdam. "Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy" Br J Sports Med 2009.
2. Starrett, Kelly. Becominutesg a Supple Leopard. Las Vegas: Victory Belt, 2015: 146-147.
3. Håkan Alfredson, Tom Pietilä, Per Jonsson and Ronny Lorentzon. "Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis". Am J Sports Med 1998 26: 360.
4. M. Kongsgaard, V. Kovanen, P. Aagaard1, S. Doessing1, P. Hansen, A. H. Laursen, N. C. Kaldau, M. Kjaer, S. P. Magnusson. "Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy". Scand J Med Sci Sports 2009: 19: 790-802