May 22, 2024 • 29 mins
Ever wondered what's truly causing that nagging tendon pain, and why rest alone isn't the cure? Saddle up for this revealing episode where we dissect the myths of insertional tendonitis and shine a light on the real culprits behind this common ailment. You'll discover the nuances between tendons, muscles, and ligaments, and learn why understanding these distinctions is crucial for effective treatment. We unravel the tangled web of overuse and poor movement patterns, offering a fresh perspective on the 'why' that drives tendon irritation, especially in athletes. It's an eye-opening journey into the body's intricate mechanics, pushing past the surface to pinpoint the root causes of tendon distress.
Rehabilitation takes center stage as we discuss knee tendonitis and the transformative power of progressive loading. Gone are the days of aggravating heavy squats; welcome a new era of tailored rehab programs designed to improve your condition with every session. We delve into the world of eccentric strengthening, a gentle yet powerful technique that builds tendon resilience without triggering pain. And get ready for the inside scoop on cutting-edge practices like blood flow restriction (BFR) training and dry needling, which mimic the benefits of intense workouts without the strain, keeping your recovery on track.
But treatment is just one piece of the puzzle; prevention is key. This episode lays out a comprehensive strategy that envelops everything from innovative therapies like dry needling and electrical stimulation to the pivotal role of daily habits such as good sleep and correct posture. With a passionate invitation for athletes and active individuals to connect, I share insights from my own recovery journeys and stress the importance of a community in overcoming these physical hurdles. Let's tackle insertional tendonitis together and pave the way to enhanced athletic performance.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
What's up?
Y'all?
It's your man, dr Kyle.
Welcome back to the DrivenAthlete Podcast.
Insertional tendonitis and howcan?
What do we do?
(00:20):
How are we going to tackle this, right?
All right, so everyone'sfamiliar with tendonitis, right,
it's when a tendon getsoverwhelmed and overloaded and
it gets irritated.
Right, and insertionaltendonitis would be where the
tendon connects to the bone thatit connects to and moves.
Okay, so, just, I'm not tryingto insult anyone's intelligence,
(00:40):
I want to make sure we're onthe same page.
All right, muscles connect tobones via tendons.
Ligaments connect bone to bone.
Okay, so a tendon connectsmuscle to a bone and ligaments
connect a bone to a bone.
So ligaments are actuallypassive structures, okay, they
don't have any action, movements, and they're there just for
passive stability.
(01:01):
Passive stability, so ligamenttears and ligament sprains.
There's too much weight placedon that, in my opinion, for,
like, rehabbing athletes oremphasis on like well, the
ligaments sprained.
That doesn't really create alot of dynamic stability anyway.
It actually doesn't create anydynamic stability.
(01:21):
It's there for passivestability, the dynamic stability
comes from all the muscles andmovement coordination around the
joint itself, okay, but anyway.
So tendons get overwhelmed,right, and they get irritated
and a tender, overwhelmed, litup tendon guaranteed.
Going to be a diagnosis oftendonitis by any healthcare
practitioner and orthopedics.
Especially.
The question that we ask asmovement specialists we're
(01:45):
movement practitioners, allright, so we're going to have
movement-based diagnoses, allright, our diagnosis will be
movement-based because we'removement practitioners, all
right, that's what we do.
We can't do anything about thepassive structures anyway and
the anatomical differences.
Anyway, tendons get overwhelmedand overloaded, for sure,
athletes have definitely activepeople.
It happens very often.
(02:05):
The question we ask is why,okay, what is the cause of the
cause?
You have tendonitis?
That's not that hard to figureout.
But why?
Okay, definitely.
What structure?
What's the tendon?
But why is that tendon inparticular getting all
overwhelmed and lit up?
These tendons get overwhelmedand lit up because too much is
required upon them.
They can't handle what strainand load is being placed on them
(02:28):
, right.
So imagine, like jumper's knee,patellar tendonitis right in the
front of the kneecap, which isdefinitely patella from oral
pain, by the way like, why isthat tendon getting all lit up?
Just overuse?
I hear that all the time andit's not.
Of course you can do too much.
You need to rest and recovertotally, but overuse is a
(02:49):
cop-out diagnosis in my opinion.
I think it just demonstrates alack of diving into the matter
and into the material or intothe issue and it's just a
cop-out diagnosis, just likesciatica.
In my opinion it's a trash canterm that just means like
collecting a bunch of things inone of like.
Just the sciatic nerve is litup, okay, but why?
Why is this for tendonitis?
(03:10):
Why is the patellar tendongetting lit up?
Why is the lateral epicondyletendon getting the common
extensor tendon Okay, is whatthat is right in the lateral
epicondyle for tennis elbow, themedial epicondyle epicondyle,
the common flexor tendon.
Why are those tendons gettingall lit up Right, overuse?
Let me ask you you play tennis,you play golf, you run, you
(03:30):
exercise, you do squats.
Do you know anybody else thatalso does the same level of
squats that you do?
A ton of people.
So why don't they and all yourcolleagues and friends have
tendonitis?
There's got to be somethingdifferent than you're doing,
right.
Another very similar one is likerotator cuff tendonitis.
Okay For a little league, forbaseball players, okay, or
(03:53):
volleyball or swimmers orsomething like that, and it's
like well, it's overuse.
Do you have any friends orteammates that also throw the
baseball at the same amount thatyou do?
Volume-wise?
Are you doing an excessivelyamount over more than what
everybody else is doing?
Probably not.
Probably very, very similar,but why don't all your other
teammates have this tendonitis?
What is it that you're doingdifferently?
(04:13):
That's what we need to ask why.
Why is this tendon getting litup?
Right?
So it's a superficial top layerdiagnosis of like my tendon
hurts.
Okay, we know it's not thathard to figure that out.
Right, cool, got the diagnosis.
So come and see a movementspecialist like us at Athlete
Restoration, co Sports PT.
We're going to ask why, though?
(04:34):
Why is this individual athletedeveloping tendonitis versus all
of his colleagues or hercolleagues and friends?
Right, overuse is not a greatanswer.
They're doing somethingdifferent.
We have to unveil that andfigure it out and deep dive into
what the cause of that cause ofpain is.
What's the cause of the cause?
The cause of the pain is atendon that's all lit up, but
(04:55):
what's the cause of that cause?
That's what we need to figureout, and it usually lies because
number one because the tendon'soverloaded and overwhelmed.
It's overcompensating right Forsomething else that's not doing
its job or contributing enough.
There's compensations instrength, recruitment and
movement patterns.
There's strength in recruitmentcompensations.
It's not like somebody's weak,it's more of like what muscle is
(05:16):
getting recruited more thanother muscles that neighbor and
connect to that area.
All right, because the onethat's overly dominant and doing
way too much and workingovertime is going to get all lit
up and irritated and tendonitis.
And the ones that aren'tcontributing enough and
recruited enough and activatedand accessed well enough aren't
going to help.
So it's like in a job there'sovertime workers and there's
(05:37):
people who barely do the bareminimum.
Who's going to get tired andoverwhelmed first?
The ones that aren't doinganything or the people who are
overworking and doing overtimeall the time?
Of course the burnout ones,that'll be the overworkers and
those that's.
That's that tendon.
So we look at it as like thattendon is the victim.
It's not the problem, it's it'sjust overwhelmed and overloaded
.
We need to fix this thing right.
(05:57):
It's overwhelmed and overloaded.
So how do I and how can wefigure that out?
Usually there's a.
There's a muscle strength,recruitment, instability,
compensation disparity of theneighboring structures.
There's also a mobilitydisparity in the neighboring
joints.
If some joints aren't movingwell enough and other ones are
moving way too much and they'rehypermobile, which ones do you
(06:17):
think are going to take thebrunt of the movement and
initiating movement?
It's, of course, thehypermobility joints.
So are we going to manipulateand mobilize hypermobile joints?
No, okay, they're alreadymoving enough, they're already.
You're actually I'm maybeunstable Okay, we need to
mobilize the ones that aren'tmoving well enough.
And those are the ones thatusually neighbor it, that
(06:38):
contribute to whatever yourathletic move is for throwing,
for running, for swimming,volleyball hits, like whatever
squats what other joints arerequired in that movement?
And those ones that aren'tmoving well enough.
That's where we need tointervene with our manual
therapy and mobility okay,manipulations and joint
mobilizations and then work onsoft tissue restrictions.
Does that make sense?
(06:58):
And the last component isdynamic stability.
We have to fix the movement,coordination and control of
these joints and your limb, allthese body parts that contribute
to this athletic move andactive movement.
Okay, and that dynamicstability, right.
We have to fix that mechanicalflaw, the biomechanical flaw
that otherwise is going to causethe hypermobile joint and the
(07:20):
over-recruited muscle to getoverwhelmed all the time that
tissue is going to get lit up.
It's doing too much and it'strying to hang on for dear life,
but it can't, and so it'sfailing at this point.
So, with that being said, ifthat's the cause of the problem,
will an injection fix that?
Unfortunately, no.
It's going to make things feelbetter Totally, and if somebody
needs I don't hate injections Ifsomebody with the right mindset
(07:43):
going into them.
They're not a solution, they'rejust to get things to decrease
inflammation and pain real quick, right away, to get things
feeling better so that someonecan live their life and not be
in agony, right?
Or if an athlete has, like aplayoff game tomorrow and they
have, they need to play andtheir season is about to end,
otherwise, right, that's.
That's where someone needs tomake a decision of like do I
just do an injection?
(08:03):
I can be pain-free real quickand then handle it.
But then usually afterwardsit's like man, my ankle hurts
terribly, or my knee was likereally bad.
There's a consequence thatcomes with that, of course, if
you just power through and playand when you're numbed up.
There's been several pro NFLfootball players I've talked
with that said the same thing.
We're like man, my knee feltgreat before games.
(08:23):
Then it definitely felt a lotworse the next day.
So solution work through somestuff, take some
anti-inflammatories for the nextweek and then get another
injection pre-game the next weekFeels great.
Then it hurts even worse.
Same process Get some treatmentwith anti-inflammatory meds and
(08:45):
then another injection the nextweek.
It's a bummer, but I mean it'shonest, I can, I get it Cause I
was a high, I like to callmyself a high level athlete.
Back in the day, back in theglory days, I get it Like you
want to.
You need to play right.
The number one factor for anathlete to be effective and
produce and their value is beingable to play, their playing
(09:05):
time, their durability.
Can you just get back on thefield or the court right, or in
the pool or on the tennis court,on the golf course, whatever?
You need to get out there andplay Otherwise like you're not
able to showcase yourself,you're not producing, you can't
do anything right, you're notactually playing.
So playing time and thedurability, therefore, is the
number one value for an athlete.
But anyway.
(09:25):
So, with that being said,different approach, let's figure
out why this tendon got a lipin the first place, for this
insertional tendonitis.
So what we got to do.
Here's what we got to do.
Here's what we got to do.
To fix tendonitis, we have toimprove the mobility disparities
, the range of motion andmobility disparities of lack of
mobility or hypermobility in theneighboring joints.
(09:46):
We have to identify what thoseare and then intervene
appropriately.
All right, with joint mobilitywork, mobilizations and
manipulations as appropriate andnecessary.
And then, surrounding softtissue restrictions, there's
soft tissue that can restrictthe motion too and create and
contribute to the hypomobilityof these joints.
Right, so the soft tissuearound there, we can work the
(10:06):
soft tissue.
We got to do soft tissue work.
We definitely need to.
You can't neglect that.
Scraping, like Graston as anexample, a tissue assisted
scraping, stripping, is usuallyour go-to.
It doesn't really feel good,but we know that active people
and athletes want results.
They don't want treatment, theywant like results.
All right.
So it's just pain with a, it'sjust discomfort.
Right With a purpose Cause weknow it's going to fix something
(10:31):
.
Um, cupping, I love cupping,I'm a huge cupping fan.
All right, it lifts andseparates the tissue, breaks up
adhesions, develops um, betterfiber gliding so things would be
more parallel and also bringsblood flow and breaks up
capillaries for better, uh,blood flow and nutrients
delivering.
Um.
And then the last thing is dryneedling.
Dry needling can be reallyeffective to help with soft
(10:53):
tissue restrictions too bydecreasing acetylcholine
reuptake and help with musclerelaxation.
It also helps to break up knotslike tissue adhesions and lay
down new fibroblast tissue forangiogenesis development of
collagen.
But anyway, I'll get into thatin a second.
So we have to improve jointmobility disparities, all those
factors, and manual therapy iswhat that is.
We have to do manual therapy.
(11:13):
It really sets things up forsuccess for the joints to move
better.
Unfortunately, joint play andsome of the joint mobility can't
be fixed with exercise alone.
We have to intervene manually.
There has to be an externalforce that intervenes to improve
and fix those mobilitydisparities and that's manual
(11:36):
therapy.
So we are huge manual therapyadvocates.
Athletes and active people needmanual therapy to set the
joints up for success andaddress those compensation
patterns in the joint range ofmotion and mobility.
Okay.
So once we improve the jointmobility, compensatory mobility
issues in a specific, directlytargeted way right, this is
purposeful discretion Then wecan implement the corrective
(11:59):
exercises and that's where wefix the compensational movement
pattern dysfunctions.
Okay, and muscle recruitmentdisparities.
We have to get the muscles torecruit around it, the other
muscles that contribute to thisaction that you do for tennis or
golf.
There's other muscles required.
As an example, for the elbowthere's usually a link in the
scapula in the shoulder of likean issue, a compensation pattern
(12:20):
, a lack of scapular stabilityright, or rotator cuff
activation, rotator cuffstrength and stability right or
rotator cuff activation, rotatorcuff strength and stability,
stabilizing the shoulder joint.
There's usually a link withthat for LO that we're finding
All right but anyway.
So we have to address that.
It's contributing to themovement of your athletics and
that's making that tendon getoverwhelmed.
So corrective exerciseimplementation by fixing the
(12:40):
recruitment, compensation issuesand strength issues and dynamic
stability issues, which is likea movement control and
coordination problem.
All right, if somebody is movingand diving into not the best
learned movement pattern, wehave to fix that learned
movement pattern.
It's unlearn some things andlearn new things, and that
ultimately fix will fix thedynamic stability issues with
(13:03):
the corrective exercises.
So the manual therapy in the,in the mobility work, sets
things up for success so theycan move better.
Now that they're moving better,let's solidify and solve the
problem with corrective exercise.
Okay, that's what we had to do,all right.
So then now the things aremoving better and they actually
solidifies the movement patterns, improving the dynamic
stability and enable the musclesto tolerate and handle the load
(13:26):
better.
Okay, that's when it's called.
We go into load reintroduction.
Okay, load training as in.
Like, if somebody has kneetendonitis, we're not going to
be able to squat 400 pounds thatday, right, the tendon would
get overloaded and overwhelmed.
We don't want to light thingsup over and over again.
Okay, and that's the thirdpoint I'm going to say in a sec,
(13:47):
we have to, um, progressivelyload things to a good tolerance
level and not light stuff up.
So when somebody leaves uh, ona point, a session with us and
our appointment, um, work withus, the goal is for them to
leave feeling better than whenthey came in, versus like just
doing it anyway.
Right, it's too much load forthe tissue right now to handle.
(14:07):
And if you can do it but ithurts, is that ultimately going
to help?
It's going to light stuff upand it's going to take two steps
back.
We take one step forward and wedo too much and get too
aggressive.
Take two steps back.
That's going to be a stalemate.
It's going to be frustratingand difficult for everybody.
It's going to be frustrating,wasted money and time for
everybody, all right.
So, um, heating the advice thatwe're suggesting it's like
(14:30):
don't do too much too quick,right With a load it
progressively.
And eccentrics is a great way towork on that in a non
irritating, non painful way tohelp lay down new collagen.
Um, integrity of the tendonimprove the integrity, tensile
strength of the tendon.
Eccentric strengthening is agreat avenue to do that,
according to the research, andone of the main things is not
(14:52):
creating more pain andirritation.
So, like I said, if somebodyever hurts, we have to change it
.
If it causes pain, we gotta fixit, we gotta change it up.
If the pain comes back laterthat day or that night or the
next day, then we gotta coursecorrect right.
So we always ask him for thisfeedback How'd you feel when you
(15:12):
leave?
How'd you feel that night?
How'd you feel the next morning?
How'd you feel that day, thenext day, today, upon arrival,
how do you feel, right, likewell, it does hurt a little bit.
What'd you do?
Oh, I didn't do anything.
What'd you do?
Well, I did do this and I waslike well, that might be too.
(15:34):
If you want to see results, wehave to be pretty vigilant and
aware of what things are causingissues and we can't light it up
over and over again.
Anyway, with that being said, wehave to improve the dynamic
stability and then load itappropriately and progressively,
and eccentrics is a great wayto help intervene and add in and
implement.
The other thing on top of thatis BFR blood flow restriction
All right.
So for tendonitis, we can loadit with eccentrics and then we
can also load it in a very smallway while it's restricted in
(15:54):
its blood, while it's restrictedin its blood flow and that has
been found in the research toreally help improve strength
gains without actually having toload it a ton of weight, all
right.
So, as an example, for ACLrepair right, or someone with
knee tendonitis right, we canapply a blood restriction, blood
flow restriction cuff aroundtheir femoral artery on the top
(16:15):
of their thigh and it feelsreally tight and it restricts
blood flow down the rest of theleg.
And while it's in that state,you exercise it.
All right, you load it, youpurposely put strain through the
tendons and the muscles and thejoints, but not a lot is
required, which is great,because that means we don't have
to overload the tissue toactually get the strength gains,
(16:36):
as if you were so.
It's really cool.
You can load it at a very smallrate that it can tolerate but
the body reacts in a way as ifyou did load it with like 300
pounds.
It's really cool.
It kind of tricks your body toreact in a certain way.
There's a neural, neurologicalresponse and an endocrine
response that helps to withthose changes, with that benefit
(16:56):
of strength improvements, whichis cool.
Dry needling is really helpful,like I was mentioning.
I want to get and dive into thata little bit for insertional
tendonitis.
It helps to stimulatefibroblast activity to lay down
new collagen fibers.
It helps to stimulate thehealing response and improve
tendon integrity.
It creates angiogenesis, whichis development of new blood
(17:17):
capillaries and blood vesselsaround the area for new blood
flow and stimulate bloodactivity for nutrients and
oxygen delivery.
It helps to recruit endogenousopioids for symptom relief
Endogenous being like your ownself-natural opioids and it
helps for just making thingsfeel better.
And then adding the electricalstim on top of that from the
(17:39):
research that's describing, theelectrical stim helps to amplify
those effects.
So we'll put electrical stim onwhile the needles are inside
someone's muscles or tendons andthe joint spaces and it helps
to amplify the effects of thosebenefits I just described.
But the number one thing overallfor insertional tendonitis and
somebody battling tendonitisissues is don't F it up over and
(18:00):
over again.
Okay, this is the hardest part,especially for active, driven
people that are like I want toget after it, I'm getting cabin
fever.
I'm tired of just resting.
First of all, don't rest, justmodify.
We're going to modify youractivities.
Don't do this, do that.
Okay.
What can I do, what can I notdo?
Your symptoms will tell you,okay.
So be aware and mindful of yourbody.
Your body's going to tell youif it hurts when you're doing
(18:20):
this.
It might or change the volume,all right, just do less, just
modify a little bit so that whenyou're doing it doesn't hurt.
After you're done doing itdoesn't hurt worse.
The next day it doesn't hurtworse, perfect, all right.
That's where we want to stay atand that's going to change day
to day.
So, being mindful and ridingthat roller coaster hopefully
(18:41):
it's not a huge dramatic rollercoaster and there is a reason.
Usually people are doing toomuch too fast but maybe a small
road because there's gonna begood days and bad days.
But a small roller coaster andover the period of several weeks
, that's we have a positivetrend and you have improvements
and then you're back to doingthe thing that you want to do
without pain.
Boom, that's a win-win.
But it can't be.
We can't cut corners or skipsteps.
If that makes sense, um, butanyway, we can't F it up over
(19:03):
and over again.
We have to stop the bleeding,metaphorically, and we have to
get things to settle down.
Okay, so we have to allowthings to settle down.
And a huge another aspect justmodifying your activity, but the
other huge aspect is sleepposture.
We can't neglect sleepingposition, prolonged positions,
work posture, driving posture,eating posture, watching TV
(19:25):
posture and sleep posture.
Sleep is the first thing wetalk about with all our patients
.
The position that you putyourself in can set things up
for irritation and it allows itto maybe to not be in an
advantageous position to healand recover, because healing and
recovery is the main goal forsleep.
Of course, if we're puttingourselves in positions that
don't really allow andfacilitate that, we're actually
(19:45):
hindering the healing potentialand maybe even actually
contributing to more irritation,which is no bueno right.
So being mindful of sleepposture is a game changer.
We talk about that with all ourpatients right away, because
very often people will come inand be like it still hurts.
I just woke up and my knee hurts.
What'd you do?
Oh, I just slept.
How about the night before?
(20:06):
How did it feel before you wentto bed that night?
It was fine, I was just doinghomework, right.
Or I was just like watching TVwith my, with my kiddos.
Um, what about earlier that day?
What'd you do?
I just rested, right.
I did everything.
The doc told me, the orthopedic.
They were like just rest andtake Advil.
It's like, okay, that's notgoing to be huge.
(20:32):
Like there's other things wecan implement.
Um, that's not going to solveany problems, like we've talked
about at length.
Um, and there's a time andplace for that stuff, but in
this, in non-traumatic, chronicissues of movement disparity
issues, that's not going tosolve those movement disparity
issues.
So, anyway, they're like yeah,it didn't do anything and it
hurts.
Woke up this morning.
Hurts hurts.
Reason does.
I'm an anomaly, doesn't makesense.
What position did you sleep at?
So you went to bed feeling Okay.
That day before you didn't doanything to provoke it.
(20:53):
Went to bed feel fine, woke upthis morning and it hurts.
So the only thing you did inbetween was sleep.
What position did you sleep in?
Well, I slept on my stomach,okay how, with my neck rotated
all the way 90 degrees and myshoulder up.
It's like and your neck hurtstoday, right, or your shoulder,
your rotator cuff, your shoulderhurts this morning.
It's like there is acorrelation here, like your
(21:14):
position in your sleep isdefinitely can affect and
irritate stuff or set it up forfailure, unfortunately.
So sleep position hurts right,or my knee hurts right.
And they slept in the fetalposition all night with their
knees fully flexed, fully bent,and then when they wake up and
they extend their knee, it'slike, oh, it hurts right, it was
just hyper-stretched all night,right, and a tissue like your
(21:35):
patellar tendon that getsoverloaded and overwhelmed can
chronically get overstretchedright and it gets lit up and
irritated and it's overwhelmed.
Imagine doing a quad stretchwith your knee to your butt all
night for eight hours, notmoving right.
It's maintained in thathyperflexed, full flexion
position for a long, many, manyhours.
Do you think when youstraighten it it's going to feel
(21:56):
great?
Probably not.
It's overwhelmed.
It just contributed to itsirritation, right.
So we have to be mindful andaware of that.
It's just one contributingfactor.
That's a very influentialcontributing factor that sets
the whole stage for things tonot get better for no reason,
right, it just plays a role, allright.
So all of this collectively iswhat ultimately creates lasting
(22:17):
results and decreases the risksof this issue returning and
actually solves the underlyingproblem.
All right.
So a big, huge component ofthis is education and also
lowering the risk of thesethings coming back in the future
.
What's preventing it fromhappening again?
Fixing the actual underlyingcause of the problem, which is
usually the mobility disparities, muscle recruitment, dynamic
stability and movement flawproblems.
(22:39):
That all collectively isusually what brings things about
like this.
Adding in sleep, posture,mobility, soft tissue work, not
effing it up over and over again.
Those are all the things thatcollectively can help solve this
problem, prevent it from comingback again.
It's interesting, though,talking about this movement
pattern stuff, right, somovement system dysfunctions is
(23:02):
a collective amount of all thejoints that surround and all the
muscle tissue and all therecruitment disparities, and all
those things contribute the waythat person moves and grooves
with not the best dynamicstability or control, not the
best coordination through themovement and overloading the
(23:25):
tissue right, all those thingsthat we would call that a
movement system impairment ormovement system dysfunction, and
particularly in athletes andactive people, that's people
that, um it just.
My pain came out of nowhere,like it just started hurting.
My shoulder started hurting forno reason three months ago.
But those learned movementpatterns over several years get
reinforced over and over withevery single rep.
(23:46):
From a young child toadolescence, into early
adulthood, into adulthood, thoselearned movement patterns
develop and those get reinforcedwith every rep over and over
again.
And so it's like how does thiseven start?
Man, I don't know, right Beyondme, probably when they were a
kid, they just learned how tomove a certain way and they were
predisposed and set up withinthose movement patterns to then
(24:08):
develop these issues later,years later, because these
movement patterns werereinforced and always
recalibrated constantly and itjust overloaded the same tissue
over and over and over again.
That no one's going to go to aphysical therapist and say like,
hey, how's my running form?
Am I doing any movement systemimpairments?
You know what I mean.
So no one's going to reallydive into this until they
actually have symptoms and it'slike, how did this start in the
(24:29):
first place?
This is really what we wouldconsider to be the answer.
It's a movement systemimpairment.
So these learned movementpatterns sometimes it's hard
that's been ingrained for yearsis very difficult to unlearn,
right, it's more difficult tounlearn something that's
ingrained than it is to learnsomething new, most of the time
(24:49):
for these active people andathletes.
So that's why it takes a littlebit of time to educate and just
work through this stuff.
So it's interesting that what Idid not mention in this
conversation.
The question is I havetendonitis, insertional
tendonitis how do I fix it?
Right, what we did not talkabout as a game-changing
(25:12):
implementation intervention isice Interesting, right.
Unfortunately, heat or ice, thevalidity behind what it's
purported to do in the researchis pretty weak.
Okay, the evidence is prettyweak to support that it does
what it's actually purported todo, which is decrease
(25:32):
inflammation.
Right, that's what the wholethought is around the public.
It's like oh, ice it, it'sgoing to decrease inflammation.
It's not going to getinflammation that's currently in
there out.
Okay, it's a constrictorno-transcript.
(25:57):
So what they suggest is likeafter 48 to 72 hours of an
injury, ice really isn't aseffective in preventing more
inflammation from getting inthere.
That's already happened.
That's too late, right?
So icing it for no reason, isnot really going to help prevent
getting inflammation out.
Okay.
And then heat same thought isuh, it's supposed to be a
dilator, it could be good forsymptom relief, but it's not.
(26:19):
It's not really going to helpwith joint mobility.
All right, and warming things up.
The best thing to warm thingsup is actually moving, and
moving it, just not in a painfulway.
But so the first question weask with this is like do you
enjoy ice?
Do you like it or do you likeheat?
Do you think it helps you?
That's the number one factorthat we'll ask Okay, then do it,
it's not going to kill you.
We're not going to prioritizeit or emphasize it because it's
(26:42):
not going to solve yourunderlying problem.
So, to summarize this real quicksomebody comes in with
tendonitis.
What do you do?
Insertional tendonitis how canwe fix this tendonitis?
Well, number one, coming from amindset that it happened
because of an overload, overuse.
That's not overuse, it'soverloaded with poor mechanics
over a long period of time.
Right, overloaded with poormechanics.
(27:03):
So that's a mobility disparity,muscle recruitment, strength,
dynamic stability, movementsystem problem.
Okay, and that's what we haveto come from it as.
So how do we treat it?
Well, we got to fix the jointrange of motion mobility
disparities.
With joint mobility.
We have to fix the soft tissuerestrictions around it.
We can address the actualtendon itself with dry needling,
cupping to stimulate healingresponse of all the things we
(27:25):
talked in the past.
Then we have to load andstrengthen things and fix the
actual movement disparityproblems, okay, the movement
coordination problems, loadingit with BFR, blood flow
restriction and also eccentricsand then also fixing the
movement patterns.
That's what we have to work on.
And the number one thing overallis just don't chronically F it
up over and over again.
(27:45):
Don't make it worse again andagain and again and again.
That's a great way to allowthings to linger.
Okay, so, with athletes that weworked with and active people,
the issue with tendonitis is itlingers forever.
It's just not getting better.
It lingers.
The lingering comes from notfixing things we talked about
and then also constantly justeffing it up, constantly just
(28:06):
irritating it a little bit.
That allows a hypervigilanttissue and the nerves that are
in there too, that arehypervigilant and sensitive, um
to to really getting irritatedagain easily.
Right, so that's the mainproblem.
And, uh, the number one thing wefind with active patients is
(28:26):
going back into things too muchtoo quickly because usually they
feel pretty good after a coupleof sessions and then they dive
into it too much quick and thatlights it up okay and it makes
things worse.
So doing too much too fast candefinitely set it up for failure
.
So it's like, hey, hang on, bemindful of your activity, like
what you're doing, if it causessymptoms, and back it up a
(28:47):
little bit.
We don't want to just powerthrough because they're going to
take five steps backwards againand we're starting everyone and
everybody's frustrated, right,everybody's frustrated and it's
a waste of money and time foreverybody.
So not doing too much tooquickly is the hardest part for
athletes and active people and Itotally get it.
I've been in that boat too.
So if you have any questionsabout this, about your own 10
and 90s you've been battling, orwhy it happened in the first
(29:07):
place or how we can treat it,definitely reach out.
We'd love to talk with you.
You can reach us best at561-899-8725 is our phone number
, or our administrative email,which is team at athlete rccom,
cause we'd love to chat with youand help you, cause, like I
said, we live vicariouslythrough our patients and we know
that this has been an issue forus.
This is a huge common issue forathletes and active people that
(29:29):
we've battled ourselves in thepast and that we're passionate
about.
And we just nerd out on thisstuff because we live
vicariously through our patients.
So we're just passionate aboutthis stuff.
We want to help you.
There is a solution, all right.
We do this very often and allthe time, so we want to bring
hope to people that it can besolved.
So definitely don't hesitate toreach out.
We'd love to talk to you andwe'll catch y'all next time.
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
What's up?
Y'all?
It's your man, dr Kyle.
Welcome back to the DrivenAthlete Podcast.
Insertional tendonitis and howcan?
What do we do?
(00:20):
How are we going to tackle this, right?
All right, so everyone'sfamiliar with tendonitis, right,
it's when a tendon getsoverwhelmed and overloaded and
it gets irritated.
Right, and insertionaltendonitis would be where the
tendon connects to the bone thatit connects to and moves.
Okay, so, just, I'm not tryingto insult anyone's intelligence,
(00:40):
I want to make sure we're onthe same page.
All right, muscles connect tobones via tendons.
Ligaments connect bone to bone.
Okay, so a tendon connectsmuscle to a bone and ligaments
connect a bone to a bone.
So ligaments are actuallypassive structures, okay, they
don't have any action, movements, and they're there just for
passive stability.
(01:01):
Passive stability, so ligamenttears and ligament sprains.
There's too much weight placedon that, in my opinion, for,
like, rehabbing athletes oremphasis on like well, the
ligaments sprained.
That doesn't really create alot of dynamic stability anyway.
It actually doesn't create anydynamic stability.
(01:21):
It's there for passivestability, the dynamic stability
comes from all the muscles andmovement coordination around the
joint itself, okay, but anyway.
So tendons get overwhelmed,right, and they get irritated
and a tender, overwhelmed, litup tendon guaranteed.
Going to be a diagnosis oftendonitis by any healthcare
practitioner and orthopedics.
Especially.
The question that we ask asmovement specialists we're
(01:45):
movement practitioners, allright, so we're going to have
movement-based diagnoses, allright, our diagnosis will be
movement-based because we'removement practitioners, all
right, that's what we do.
We can't do anything about thepassive structures anyway and
the anatomical differences.
Anyway, tendons get overwhelmedand overloaded, for sure,
athletes have definitely activepeople.
It happens very often.
(02:05):
The question we ask is why,okay, what is the cause of the
cause?
You have tendonitis?
That's not that hard to figureout.
But why?
Okay, definitely.
What structure?
What's the tendon?
But why is that tendon inparticular getting all
overwhelmed and lit up?
These tendons get overwhelmedand lit up because too much is
required upon them.
They can't handle what strainand load is being placed on them
(02:28):
, right.
So imagine, like jumper's knee,patellar tendonitis right in the
front of the kneecap, which isdefinitely patella from oral
pain, by the way like, why isthat tendon getting all lit up?
Just overuse?
I hear that all the time andit's not.
Of course you can do too much.
You need to rest and recovertotally, but overuse is a
(02:49):
cop-out diagnosis in my opinion.
I think it just demonstrates alack of diving into the matter
and into the material or intothe issue and it's just a
cop-out diagnosis, just likesciatica.
In my opinion it's a trash canterm that just means like
collecting a bunch of things inone of like.
Just the sciatic nerve is litup, okay, but why?
Why is this for tendonitis?
(03:10):
Why is the patellar tendongetting lit up?
Why is the lateral epicondyletendon getting the common
extensor tendon Okay, is whatthat is right in the lateral
epicondyle for tennis elbow, themedial epicondyle epicondyle,
the common flexor tendon.
Why are those tendons gettingall lit up Right, overuse?
Let me ask you you play tennis,you play golf, you run, you
(03:30):
exercise, you do squats.
Do you know anybody else thatalso does the same level of
squats that you do?
A ton of people.
So why don't they and all yourcolleagues and friends have
tendonitis?
There's got to be somethingdifferent than you're doing,
right.
Another very similar one is likerotator cuff tendonitis.
Okay For a little league, forbaseball players, okay, or
(03:53):
volleyball or swimmers orsomething like that, and it's
like well, it's overuse.
Do you have any friends orteammates that also throw the
baseball at the same amount thatyou do?
Volume-wise?
Are you doing an excessivelyamount over more than what
everybody else is doing?
Probably not.
Probably very, very similar,but why don't all your other
teammates have this tendonitis?
What is it that you're doingdifferently?
(04:13):
That's what we need to ask why.
Why is this tendon getting litup?
Right?
So it's a superficial top layerdiagnosis of like my tendon
hurts.
Okay, we know it's not thathard to figure that out.
Right, cool, got the diagnosis.
So come and see a movementspecialist like us at Athlete
Restoration, co Sports PT.
We're going to ask why, though?
(04:34):
Why is this individual athletedeveloping tendonitis versus all
of his colleagues or hercolleagues and friends?
Right, overuse is not a greatanswer.
They're doing somethingdifferent.
We have to unveil that andfigure it out and deep dive into
what the cause of that cause ofpain is.
What's the cause of the cause?
The cause of the pain is atendon that's all lit up, but
(04:55):
what's the cause of that cause?
That's what we need to figureout, and it usually lies because
number one because the tendon'soverloaded and overwhelmed.
It's overcompensating right Forsomething else that's not doing
its job or contributing enough.
There's compensations instrength, recruitment and
movement patterns.
There's strength in recruitmentcompensations.
It's not like somebody's weak,it's more of like what muscle is
(05:16):
getting recruited more thanother muscles that neighbor and
connect to that area.
All right, because the onethat's overly dominant and doing
way too much and workingovertime is going to get all lit
up and irritated and tendonitis.
And the ones that aren'tcontributing enough and
recruited enough and activatedand accessed well enough aren't
going to help.
So it's like in a job there'sovertime workers and there's
(05:37):
people who barely do the bareminimum.
Who's going to get tired andoverwhelmed first?
The ones that aren't doinganything or the people who are
overworking and doing overtimeall the time?
Of course the burnout ones,that'll be the overworkers and
those that's.
That's that tendon.
So we look at it as like thattendon is the victim.
It's not the problem, it's it'sjust overwhelmed and overloaded
.
We need to fix this thing right.
(05:57):
It's overwhelmed and overloaded.
So how do I and how can wefigure that out?
Usually there's a.
There's a muscle strength,recruitment, instability,
compensation disparity of theneighboring structures.
There's also a mobilitydisparity in the neighboring
joints.
If some joints aren't movingwell enough and other ones are
moving way too much and they'rehypermobile, which ones do you
(06:17):
think are going to take thebrunt of the movement and
initiating movement?
It's, of course, thehypermobility joints.
So are we going to manipulateand mobilize hypermobile joints?
No, okay, they're alreadymoving enough, they're already.
You're actually I'm maybeunstable Okay, we need to
mobilize the ones that aren'tmoving well enough.
And those are the ones thatusually neighbor it, that
(06:38):
contribute to whatever yourathletic move is for throwing,
for running, for swimming,volleyball hits, like whatever
squats what other joints arerequired in that movement?
And those ones that aren'tmoving well enough.
That's where we need tointervene with our manual
therapy and mobility okay,manipulations and joint
mobilizations and then work onsoft tissue restrictions.
Does that make sense?
(06:58):
And the last component isdynamic stability.
We have to fix the movement,coordination and control of
these joints and your limb, allthese body parts that contribute
to this athletic move andactive movement.
Okay, and that dynamicstability, right.
We have to fix that mechanicalflaw, the biomechanical flaw
that otherwise is going to causethe hypermobile joint and the
(07:20):
over-recruited muscle to getoverwhelmed all the time that
tissue is going to get lit up.
It's doing too much and it'strying to hang on for dear life,
but it can't, and so it'sfailing at this point.
So, with that being said, ifthat's the cause of the problem,
will an injection fix that?
Unfortunately, no.
It's going to make things feelbetter Totally, and if somebody
needs I don't hate injections Ifsomebody with the right mindset
(07:43):
going into them.
They're not a solution, they'rejust to get things to decrease
inflammation and pain real quick, right away, to get things
feeling better so that someonecan live their life and not be
in agony, right?
Or if an athlete has, like aplayoff game tomorrow and they
have, they need to play andtheir season is about to end,
otherwise, right, that's.
That's where someone needs tomake a decision of like do I
just do an injection?
(08:03):
I can be pain-free real quickand then handle it.
But then usually afterwardsit's like man, my ankle hurts
terribly, or my knee was likereally bad.
There's a consequence thatcomes with that, of course, if
you just power through and playand when you're numbed up.
There's been several pro NFLfootball players I've talked
with that said the same thing.
We're like man, my knee feltgreat before games.
(08:23):
Then it definitely felt a lotworse the next day.
So solution work through somestuff, take some
anti-inflammatories for the nextweek and then get another
injection pre-game the next weekFeels great.
Then it hurts even worse.
Same process Get some treatmentwith anti-inflammatory meds and
(08:45):
then another injection the nextweek.
It's a bummer, but I mean it'shonest, I can, I get it Cause I
was a high, I like to callmyself a high level athlete.
Back in the day, back in theglory days, I get it Like you
want to.
You need to play right.
The number one factor for anathlete to be effective and
produce and their value is beingable to play, their playing
(09:05):
time, their durability.
Can you just get back on thefield or the court right, or in
the pool or on the tennis court,on the golf course, whatever?
You need to get out there andplay Otherwise like you're not
able to showcase yourself,you're not producing, you can't
do anything right, you're notactually playing.
So playing time and thedurability, therefore, is the
number one value for an athlete.
But anyway.
(09:25):
So, with that being said,different approach, let's figure
out why this tendon got a lipin the first place, for this
insertional tendonitis.
So what we got to do.
Here's what we got to do.
Here's what we got to do.
To fix tendonitis, we have toimprove the mobility disparities
, the range of motion andmobility disparities of lack of
mobility or hypermobility in theneighboring joints.
(09:46):
We have to identify what thoseare and then intervene
appropriately.
All right, with joint mobilitywork, mobilizations and
manipulations as appropriate andnecessary.
And then, surrounding softtissue restrictions, there's
soft tissue that can restrictthe motion too and create and
contribute to the hypomobilityof these joints.
Right, so the soft tissuearound there, we can work the
(10:06):
soft tissue.
We got to do soft tissue work.
We definitely need to.
You can't neglect that.
Scraping, like Graston as anexample, a tissue assisted
scraping, stripping, is usuallyour go-to.
It doesn't really feel good,but we know that active people
and athletes want results.
They don't want treatment, theywant like results.
All right.
So it's just pain with a, it'sjust discomfort.
Right With a purpose Cause weknow it's going to fix something
(10:31):
.
Um, cupping, I love cupping,I'm a huge cupping fan.
All right, it lifts andseparates the tissue, breaks up
adhesions, develops um, betterfiber gliding so things would be
more parallel and also bringsblood flow and breaks up
capillaries for better, uh,blood flow and nutrients
delivering.
Um.
And then the last thing is dryneedling.
Dry needling can be reallyeffective to help with soft
(10:53):
tissue restrictions too bydecreasing acetylcholine
reuptake and help with musclerelaxation.
It also helps to break up knotslike tissue adhesions and lay
down new fibroblast tissue forangiogenesis development of
collagen.
But anyway, I'll get into thatin a second.
So we have to improve jointmobility disparities, all those
factors, and manual therapy iswhat that is.
We have to do manual therapy.
(11:13):
It really sets things up forsuccess for the joints to move
better.
Unfortunately, joint play andsome of the joint mobility can't
be fixed with exercise alone.
We have to intervene manually.
There has to be an externalforce that intervenes to improve
and fix those mobilitydisparities and that's manual
(11:36):
therapy.
So we are huge manual therapyadvocates.
Athletes and active people needmanual therapy to set the
joints up for success andaddress those compensation
patterns in the joint range ofmotion and mobility.
Okay.
So once we improve the jointmobility, compensatory mobility
issues in a specific, directlytargeted way right, this is
purposeful discretion Then wecan implement the corrective
(11:59):
exercises and that's where wefix the compensational movement
pattern dysfunctions.
Okay, and muscle recruitmentdisparities.
We have to get the muscles torecruit around it, the other
muscles that contribute to thisaction that you do for tennis or
golf.
There's other muscles required.
As an example, for the elbowthere's usually a link in the
scapula in the shoulder of likean issue, a compensation pattern
(12:20):
, a lack of scapular stabilityright, or rotator cuff
activation, rotator cuffstrength and stability right or
rotator cuff activation, rotatorcuff strength and stability,
stabilizing the shoulder joint.
There's usually a link withthat for LO that we're finding
All right but anyway.
So we have to address that.
It's contributing to themovement of your athletics and
that's making that tendon getoverwhelmed.
So corrective exerciseimplementation by fixing the
(12:40):
recruitment, compensation issuesand strength issues and dynamic
stability issues, which is likea movement control and
coordination problem.
All right, if somebody is movingand diving into not the best
learned movement pattern, wehave to fix that learned
movement pattern.
It's unlearn some things andlearn new things, and that
ultimately fix will fix thedynamic stability issues with
(13:03):
the corrective exercises.
So the manual therapy in the,in the mobility work, sets
things up for success so theycan move better.
Now that they're moving better,let's solidify and solve the
problem with corrective exercise.
Okay, that's what we had to do,all right.
So then now the things aremoving better and they actually
solidifies the movement patterns, improving the dynamic
stability and enable the musclesto tolerate and handle the load
(13:26):
better.
Okay, that's when it's called.
We go into load reintroduction.
Okay, load training as in.
Like, if somebody has kneetendonitis, we're not going to
be able to squat 400 pounds thatday, right, the tendon would
get overloaded and overwhelmed.
We don't want to light thingsup over and over again.
Okay, and that's the thirdpoint I'm going to say in a sec,
(13:47):
we have to, um, progressivelyload things to a good tolerance
level and not light stuff up.
So when somebody leaves uh, ona point, a session with us and
our appointment, um, work withus, the goal is for them to
leave feeling better than whenthey came in, versus like just
doing it anyway.
Right, it's too much load forthe tissue right now to handle.
(14:07):
And if you can do it but ithurts, is that ultimately going
to help?
It's going to light stuff upand it's going to take two steps
back.
We take one step forward and wedo too much and get too
aggressive.
Take two steps back.
That's going to be a stalemate.
It's going to be frustratingand difficult for everybody.
It's going to be frustrating,wasted money and time for
everybody, all right.
So, um, heating the advice thatwe're suggesting it's like
(14:30):
don't do too much too quick,right With a load it
progressively.
And eccentrics is a great way towork on that in a non
irritating, non painful way tohelp lay down new collagen.
Um, integrity of the tendonimprove the integrity, tensile
strength of the tendon.
Eccentric strengthening is agreat avenue to do that,
according to the research, andone of the main things is not
(14:52):
creating more pain andirritation.
So, like I said, if somebodyever hurts, we have to change it
.
If it causes pain, we gotta fixit, we gotta change it up.
If the pain comes back laterthat day or that night or the
next day, then we gotta coursecorrect right.
So we always ask him for thisfeedback How'd you feel when you
(15:12):
leave?
How'd you feel that night?
How'd you feel the next morning?
How'd you feel that day, thenext day, today, upon arrival,
how do you feel, right, likewell, it does hurt a little bit.
What'd you do?
Oh, I didn't do anything.
What'd you do?
Well, I did do this and I waslike well, that might be too.
(15:34):
If you want to see results, wehave to be pretty vigilant and
aware of what things are causingissues and we can't light it up
over and over again.
Anyway, with that being said, wehave to improve the dynamic
stability and then load itappropriately and progressively,
and eccentrics is a great wayto help intervene and add in and
implement.
The other thing on top of thatis BFR blood flow restriction
All right.
So for tendonitis, we can loadit with eccentrics and then we
can also load it in a very smallway while it's restricted in
(15:54):
its blood, while it's restrictedin its blood flow and that has
been found in the research toreally help improve strength
gains without actually having toload it a ton of weight, all
right.
So, as an example, for ACLrepair right, or someone with
knee tendonitis right, we canapply a blood restriction, blood
flow restriction cuff aroundtheir femoral artery on the top
(16:15):
of their thigh and it feelsreally tight and it restricts
blood flow down the rest of theleg.
And while it's in that state,you exercise it.
All right, you load it, youpurposely put strain through the
tendons and the muscles and thejoints, but not a lot is
required, which is great,because that means we don't have
to overload the tissue toactually get the strength gains,
(16:36):
as if you were so.
It's really cool.
You can load it at a very smallrate that it can tolerate but
the body reacts in a way as ifyou did load it with like 300
pounds.
It's really cool.
It kind of tricks your body toreact in a certain way.
There's a neural, neurologicalresponse and an endocrine
response that helps to withthose changes, with that benefit
(16:56):
of strength improvements, whichis cool.
Dry needling is really helpful,like I was mentioning.
I want to get and dive into thata little bit for insertional
tendonitis.
It helps to stimulatefibroblast activity to lay down
new collagen fibers.
It helps to stimulate thehealing response and improve
tendon integrity.
It creates angiogenesis, whichis development of new blood
(17:17):
capillaries and blood vesselsaround the area for new blood
flow and stimulate bloodactivity for nutrients and
oxygen delivery.
It helps to recruit endogenousopioids for symptom relief
Endogenous being like your ownself-natural opioids and it
helps for just making thingsfeel better.
And then adding the electricalstim on top of that from the
(17:39):
research that's describing, theelectrical stim helps to amplify
those effects.
So we'll put electrical stim onwhile the needles are inside
someone's muscles or tendons andthe joint spaces and it helps
to amplify the effects of thosebenefits I just described.
But the number one thing overallfor insertional tendonitis and
somebody battling tendonitisissues is don't F it up over and
(18:00):
over again.
Okay, this is the hardest part,especially for active, driven
people that are like I want toget after it, I'm getting cabin
fever.
I'm tired of just resting.
First of all, don't rest, justmodify.
We're going to modify youractivities.
Don't do this, do that.
Okay.
What can I do, what can I notdo?
Your symptoms will tell you,okay.
So be aware and mindful of yourbody.
Your body's going to tell youif it hurts when you're doing
(18:20):
this.
It might or change the volume,all right, just do less, just
modify a little bit so that whenyou're doing it doesn't hurt.
After you're done doing itdoesn't hurt worse.
The next day it doesn't hurtworse, perfect, all right.
That's where we want to stay atand that's going to change day
to day.
So, being mindful and ridingthat roller coaster hopefully
(18:41):
it's not a huge dramatic rollercoaster and there is a reason.
Usually people are doing toomuch too fast but maybe a small
road because there's gonna begood days and bad days.
But a small roller coaster andover the period of several weeks
, that's we have a positivetrend and you have improvements
and then you're back to doingthe thing that you want to do
without pain.
Boom, that's a win-win.
But it can't be.
We can't cut corners or skipsteps.
If that makes sense, um, butanyway, we can't F it up over
(19:03):
and over again.
We have to stop the bleeding,metaphorically, and we have to
get things to settle down.
Okay, so we have to allowthings to settle down.
And a huge another aspect justmodifying your activity, but the
other huge aspect is sleepposture.
We can't neglect sleepingposition, prolonged positions,
work posture, driving posture,eating posture, watching TV
(19:25):
posture and sleep posture.
Sleep is the first thing wetalk about with all our patients
.
The position that you putyourself in can set things up
for irritation and it allows itto maybe to not be in an
advantageous position to healand recover, because healing and
recovery is the main goal forsleep.
Of course, if we're puttingourselves in positions that
don't really allow andfacilitate that, we're actually
(19:45):
hindering the healing potentialand maybe even actually
contributing to more irritation,which is no bueno right.
So being mindful of sleepposture is a game changer.
We talk about that with all ourpatients right away, because
very often people will come inand be like it still hurts.
I just woke up and my knee hurts.
What'd you do?
Oh, I just slept.
How about the night before?
(20:06):
How did it feel before you wentto bed that night?
It was fine, I was just doinghomework, right.
Or I was just like watching TVwith my, with my kiddos.
Um, what about earlier that day?
What'd you do?
I just rested, right.
I did everything.
The doc told me, the orthopedic.
They were like just rest andtake Advil.
It's like, okay, that's notgoing to be huge.
(20:32):
Like there's other things wecan implement.
Um, that's not going to solveany problems, like we've talked
about at length.
Um, and there's a time andplace for that stuff, but in
this, in non-traumatic, chronicissues of movement disparity
issues, that's not going tosolve those movement disparity
issues.
So, anyway, they're like yeah,it didn't do anything and it
hurts.
Woke up this morning.
Hurts hurts.
Reason does.
I'm an anomaly, doesn't makesense.
What position did you sleep at?
So you went to bed feeling Okay.
That day before you didn't doanything to provoke it.
(20:53):
Went to bed feel fine, woke upthis morning and it hurts.
So the only thing you did inbetween was sleep.
What position did you sleep in?
Well, I slept on my stomach,okay how, with my neck rotated
all the way 90 degrees and myshoulder up.
It's like and your neck hurtstoday, right, or your shoulder,
your rotator cuff, your shoulderhurts this morning.
It's like there is acorrelation here, like your
(21:14):
position in your sleep isdefinitely can affect and
irritate stuff or set it up forfailure, unfortunately.
So sleep position hurts right,or my knee hurts right.
And they slept in the fetalposition all night with their
knees fully flexed, fully bent,and then when they wake up and
they extend their knee, it'slike, oh, it hurts right, it was
just hyper-stretched all night,right, and a tissue like your
(21:35):
patellar tendon that getsoverloaded and overwhelmed can
chronically get overstretchedright and it gets lit up and
irritated and it's overwhelmed.
Imagine doing a quad stretchwith your knee to your butt all
night for eight hours, notmoving right.
It's maintained in thathyperflexed, full flexion
position for a long, many, manyhours.
Do you think when youstraighten it it's going to feel
(21:56):
great?
Probably not.
It's overwhelmed.
It just contributed to itsirritation, right.
So we have to be mindful andaware of that.
It's just one contributingfactor.
That's a very influentialcontributing factor that sets
the whole stage for things tonot get better for no reason,
right, it just plays a role, allright.
So all of this collectively iswhat ultimately creates lasting
(22:17):
results and decreases the risksof this issue returning and
actually solves the underlyingproblem.
All right.
So a big, huge component ofthis is education and also
lowering the risk of thesethings coming back in the future
.
What's preventing it fromhappening again?
Fixing the actual underlyingcause of the problem, which is
usually the mobility disparities, muscle recruitment, dynamic
stability and movement flawproblems.
(22:39):
That all collectively isusually what brings things about
like this.
Adding in sleep, posture,mobility, soft tissue work, not
effing it up over and over again.
Those are all the things thatcollectively can help solve this
problem, prevent it from comingback again.
It's interesting, though,talking about this movement
pattern stuff, right, somovement system dysfunctions is
(23:02):
a collective amount of all thejoints that surround and all the
muscle tissue and all therecruitment disparities, and all
those things contribute the waythat person moves and grooves
with not the best dynamicstability or control, not the
best coordination through themovement and overloading the
(23:25):
tissue right, all those thingsthat we would call that a
movement system impairment ormovement system dysfunction, and
particularly in athletes andactive people, that's people
that, um it just.
My pain came out of nowhere,like it just started hurting.
My shoulder started hurting forno reason three months ago.
But those learned movementpatterns over several years get
reinforced over and over withevery single rep.
(23:46):
From a young child toadolescence, into early
adulthood, into adulthood, thoselearned movement patterns
develop and those get reinforcedwith every rep over and over
again.
And so it's like how does thiseven start?
Man, I don't know, right Beyondme, probably when they were a
kid, they just learned how tomove a certain way and they were
predisposed and set up withinthose movement patterns to then
(24:08):
develop these issues later,years later, because these
movement patterns werereinforced and always
recalibrated constantly and itjust overloaded the same tissue
over and over and over again.
That no one's going to go to aphysical therapist and say like,
hey, how's my running form?
Am I doing any movement systemimpairments?
You know what I mean.
So no one's going to reallydive into this until they
actually have symptoms and it'slike, how did this start in the
(24:29):
first place?
This is really what we wouldconsider to be the answer.
It's a movement systemimpairment.
So these learned movementpatterns sometimes it's hard
that's been ingrained for yearsis very difficult to unlearn,
right, it's more difficult tounlearn something that's
ingrained than it is to learnsomething new, most of the time
(24:49):
for these active people andathletes.
So that's why it takes a littlebit of time to educate and just
work through this stuff.
So it's interesting that what Idid not mention in this
conversation.
The question is I havetendonitis, insertional
tendonitis how do I fix it?
Right, what we did not talkabout as a game-changing
(25:12):
implementation intervention isice Interesting, right.
Unfortunately, heat or ice, thevalidity behind what it's
purported to do in the researchis pretty weak.
Okay, the evidence is prettyweak to support that it does
what it's actually purported todo, which is decrease
(25:32):
inflammation.
Right, that's what the wholethought is around the public.
It's like oh, ice it, it'sgoing to decrease inflammation.
It's not going to getinflammation that's currently in
there out.
Okay, it's a constrictorno-transcript.
(25:57):
So what they suggest is likeafter 48 to 72 hours of an
injury, ice really isn't aseffective in preventing more
inflammation from getting inthere.
That's already happened.
That's too late, right?
So icing it for no reason, isnot really going to help prevent
getting inflammation out.
Okay.
And then heat same thought isuh, it's supposed to be a
dilator, it could be good forsymptom relief, but it's not.
(26:19):
It's not really going to helpwith joint mobility.
All right, and warming things up.
The best thing to warm thingsup is actually moving, and
moving it, just not in a painfulway.
But so the first question weask with this is like do you
enjoy ice?
Do you like it or do you likeheat?
Do you think it helps you?
That's the number one factorthat we'll ask Okay, then do it,
it's not going to kill you.
We're not going to prioritizeit or emphasize it because it's
(26:42):
not going to solve yourunderlying problem.
So, to summarize this real quicksomebody comes in with
tendonitis.
What do you do?
Insertional tendonitis how canwe fix this tendonitis?
Well, number one, coming from amindset that it happened
because of an overload, overuse.
That's not overuse, it'soverloaded with poor mechanics
over a long period of time.
Right, overloaded with poormechanics.
(27:03):
So that's a mobility disparity,muscle recruitment, strength,
dynamic stability, movementsystem problem.
Okay, and that's what we haveto come from it as.
So how do we treat it?
Well, we got to fix the jointrange of motion mobility
disparities.
With joint mobility.
We have to fix the soft tissuerestrictions around it.
We can address the actualtendon itself with dry needling,
cupping to stimulate healingresponse of all the things we
(27:25):
talked in the past.
Then we have to load andstrengthen things and fix the
actual movement disparityproblems, okay, the movement
coordination problems, loadingit with BFR, blood flow
restriction and also eccentricsand then also fixing the
movement patterns.
That's what we have to work on.
And the number one thing overallis just don't chronically F it
up over and over again.
(27:45):
Don't make it worse again andagain and again and again.
That's a great way to allowthings to linger.
Okay, so, with athletes that weworked with and active people,
the issue with tendonitis is itlingers forever.
It's just not getting better.
It lingers.
The lingering comes from notfixing things we talked about
and then also constantly justeffing it up, constantly just
(28:06):
irritating it a little bit.
That allows a hypervigilanttissue and the nerves that are
in there too, that arehypervigilant and sensitive, um
to to really getting irritatedagain easily.
Right, so that's the mainproblem.
And, uh, the number one thing wefind with active patients is
(28:26):
going back into things too muchtoo quickly because usually they
feel pretty good after a coupleof sessions and then they dive
into it too much quick and thatlights it up okay and it makes
things worse.
So doing too much too fast candefinitely set it up for failure
.
So it's like, hey, hang on, bemindful of your activity, like
what you're doing, if it causessymptoms, and back it up a
(28:47):
little bit.
We don't want to just powerthrough because they're going to
take five steps backwards againand we're starting everyone and
everybody's frustrated, right,everybody's frustrated and it's
a waste of money and time foreverybody.
So not doing too much tooquickly is the hardest part for
athletes and active people and Itotally get it.
I've been in that boat too.
So if you have any questionsabout this, about your own 10
and 90s you've been battling, orwhy it happened in the first
(29:07):
place or how we can treat it,definitely reach out.
We'd love to talk with you.
You can reach us best at561-899-8725 is our phone number
, or our administrative email,which is team at athlete rccom,
cause we'd love to chat with youand help you, cause, like I
said, we live vicariouslythrough our patients and we know
that this has been an issue forus.
This is a huge common issue forathletes and active people that
(29:29):
we've battled ourselves in thepast and that we're passionate
about.
And we just nerd out on thisstuff because we live
vicariously through our patients.
So we're just passionate aboutthis stuff.
We want to help you.
There is a solution, all right.
We do this very often and allthe time, so we want to bring
hope to people that it can besolved.
So definitely don't hesitate toreach out.
We'd love to talk to you andwe'll catch y'all next time.
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