Latest / The Driven Athlete / Tendonitis Explained, Causes, & How to Fix It | Ep 33

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Tendonitis Explained, Causes, & How to Fix It | Ep 33 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up?
• 0:12
  Speaker 1: Y'all?
• 0:12
  Speaker 1: It's your man, dr Kyle.
• 0:13
  Speaker 1: Welcome back to the Driven Athlete Podcast.
• 0:17
  Speaker 1: Insertional tendonitis and how can?
• 0:20
  Speaker 1: What do we do?
• 0:20
  Speaker 1: How are we going to tackle this, right?
• 0:22
  Speaker 1: All right, so everyone's familiar with tendonitis, right, it's when a tendon gets overwhelmed and overloaded and it gets irritated.
• 0:30
  Speaker 1: Right, and insertional tendonitis would be where the tendon connects to the bone that it connects to and moves.
• 0:38
  Speaker 1: Okay, so, just, I'm not trying to insult anyone's intelligence, I want to make sure we're on the same page.
• 0:42
  Speaker 1: All right, muscles connect to bones via tendons.
• 0:45
  Speaker 1: Ligaments connect bone to bone.
• 0:48
  Speaker 1: Okay, so a tendon connects muscle to a bone and ligaments connect a bone to a bone.
• 0:53
  Speaker 1: So ligaments are actually passive structures, okay, they don't have any action, movements, and they're there just for passive stability.
• 1:01
  Speaker 1: Passive stability, so ligament tears and ligament sprains.
• 1:04
  Speaker 1: There's too much weight placed on that, in my opinion, for, like, rehabbing athletes or emphasis on like well, the ligaments sprained.
• 1:14
  Speaker 1: That doesn't really create a lot of dynamic stability anyway.
• 1:20
  Speaker 1: It actually doesn't create any dynamic stability.
• 1:21
  Speaker 1: It's there for passive stability, the dynamic stability comes from all the muscles and movement coordination around the joint itself, okay, but anyway.
• 1:27
  Speaker 1: So tendons get overwhelmed, right, and they get irritated and a tender, overwhelmed, lit up tendon guaranteed.
• 1:36
  Speaker 1: Going to be a diagnosis of tendonitis by any healthcare practitioner and orthopedics.
• 1:40
  Speaker 1: Especially.
• 1:41
  Speaker 1: The question that we ask as movement specialists we're movement practitioners, all right, so we're going to have movement-based diagnoses, all right, our diagnosis will be movement-based because we're movement practitioners, all right, that's what we do.
• 1:53
  Speaker 1: We can't do anything about the passive structures anyway and the anatomical differences.
• 1:57
  Speaker 1: Anyway, tendons get overwhelmed and overloaded, for sure, athletes have definitely active people.
• 2:04
  Speaker 1: It happens very often.
• 2:05
  Speaker 1: The question we ask is why, okay, what is the cause of the cause?
• 2:08
  Speaker 1: You have tendonitis?
• 2:10
  Speaker 1: That's not that hard to figure out.
• 2:12
  Speaker 1: But why?
• 2:13
  Speaker 1: Okay, definitely.
• 2:14
  Speaker 1: What structure?
• 2:15
  Speaker 1: What's the tendon?
• 2:16
  Speaker 1: But why is that tendon in particular getting all overwhelmed and lit up?
• 2:22
  Speaker 1: These tendons get overwhelmed and lit up because too much is required upon them.
• 2:24
  Speaker 1: They can't handle what strain and load is being placed on them, right.
• 2:29
  Speaker 1: So imagine, like jumper's knee, patellar tendonitis right in the front of the kneecap, which is definitely patella from oral pain, by the way like, why is that tendon getting all lit up?
• 2:38
  Speaker 1: Just overuse?
• 2:40
  Speaker 1: I hear that all the time and it's not.
• 2:43
  Speaker 1: Of course you can do too much.
• 2:45
  Speaker 1: You need to rest and recover totally, but overuse is a cop-out diagnosis in my opinion.
• 2:51
  Speaker 1: I think it just demonstrates a lack of diving into the matter and into the material or into the issue and it's just a cop-out diagnosis, just like sciatica.
• 3:00
  Speaker 1: In my opinion it's a trash can term that just means like collecting a bunch of things in one of like.
• 3:05
  Speaker 1: Just the sciatic nerve is lit up, okay, but why?
• 3:08
  Speaker 1: Why is this for tendonitis?
• 3:10
  Speaker 1: Why is the patellar tendon getting lit up?
• 3:12
  Speaker 1: Why is the lateral epicondyle tendon getting the common extensor tendon Okay, is what that is right in the lateral epicondyle for tennis elbow, the medial epicondyle epicondyle, the common flexor tendon.
• 3:24
  Speaker 1: Why are those tendons getting all lit up Right, overuse?
• 3:28
  Speaker 1: Let me ask you you play tennis, you play golf, you run, you exercise, you do squats.
• 3:31
  Speaker 1: Do you know anybody else that also does the same level of squats that you do?
• 3:36
  Speaker 1: A ton of people.
• 3:37
  Speaker 1: So why don't they and all your colleagues and friends have tendonitis?
• 3:40
  Speaker 1: There's got to be something different than you're doing, right.
• 3:44
  Speaker 1: Another very similar one is like rotator cuff tendonitis.
• 3:48
  Speaker 1: Okay For a little league, for baseball players, okay, or volleyball or swimmers or something like that, and it's like well, it's overuse.
• 3:56
  Speaker 1: Do you have any friends or teammates that also throw the baseball at the same amount that you do?
• 4:01
  Speaker 1: Volume-wise?
• 4:02
  Speaker 1: Are you doing an excessively amount over more than what everybody else is doing?
• 4:05
  Speaker 1: Probably not.
• 4:07
  Speaker 1: Probably very, very similar, but why don't all your other teammates have this tendonitis?
• 4:11
  Speaker 1: What is it that you're doing differently?
• 4:13
  Speaker 1: That's what we need to ask why.
• 4:15
  Speaker 1: Why is this tendon getting lit up?
• 4:16
  Speaker 1: Right?
• 4:16
  Speaker 1: So it's a superficial top layer diagnosis of like my tendon hurts.
• 4:21
  Speaker 1: Okay, we know it's not that hard to figure that out.
• 4:24
  Speaker 1: Right, cool, got the diagnosis.
• 4:31
  Speaker 1: So come and see a movement specialist like us at Athlete Restoration, co Sports PT.
• 4:33
  Speaker 1: We're going to ask why, though?
• 4:34
  Speaker 1: Why is this individual athlete developing tendonitis versus all of his colleagues or her colleagues and friends?
• 4:40
  Speaker 1: Right, overuse is not a great answer.
• 4:42
  Speaker 1: They're doing something different.
• 4:44
  Speaker 1: We have to unveil that and figure it out and deep dive into what the cause of that cause of pain is.
• 4:51
  Speaker 1: What's the cause of the cause?
• 4:52
  Speaker 1: The cause of the pain is a tendon that's all lit up, but what's the cause of that cause?
• 4:56
  Speaker 1: That's what we need to figure out, and it usually lies because number one because the tendon's overloaded and overwhelmed.
• 5:01
  Speaker 1: It's overcompensating right For something else that's not doing its job or contributing enough.
• 5:07
  Speaker 1: There's compensations in strength, recruitment and movement patterns.
• 5:10
  Speaker 1: There's strength in recruitment compensations.
• 5:14
  Speaker 1: It's not like somebody's weak, it's more of like what muscle is getting recruited more than other muscles that neighbor and connect to that area.
• 5:19
  Speaker 1: All right, because the one that's overly dominant and doing way too much and working overtime is going to get all lit up and irritated and tendonitis.
• 5:26
  Speaker 1: And the ones that aren't contributing enough and recruited enough and activated and accessed well enough aren't going to help.
• 5:33
  Speaker 1: So it's like in a job there's overtime workers and there's people who barely do the bare minimum.
• 5:38
  Speaker 1: Who's going to get tired and overwhelmed first?
• 5:40
  Speaker 1: The ones that aren't doing anything or the people who are overworking and doing overtime all the time?
• 5:45
  Speaker 1: Of course the burnout ones, that'll be the overworkers and those that's.
• 5:48
  Speaker 1: That's that tendon.
• 5:49
  Speaker 1: So we look at it as like that tendon is the victim.
• 5:52
  Speaker 1: It's not the problem, it's it's just overwhelmed and overloaded.
• 5:56
  Speaker 1: We need to fix this thing right.
• 5:57
  Speaker 1: It's overwhelmed and overloaded.
• 5:58
  Speaker 1: So how do I and how can we figure that out?
• 6:00
  Speaker 1: Usually there's a.
• 6:01
  Speaker 1: There's a muscle strength, recruitment, instability, compensation disparity of the neighboring structures.
• 6:07
  Speaker 1: There's also a mobility disparity in the neighboring joints.
• 6:11
  Speaker 1: If some joints aren't moving well enough and other ones are moving way too much and they're hypermobile, which ones do you think are going to take the brunt of the movement and initiating movement?
• 6:21
  Speaker 1: It's, of course, the hypermobility joints.
• 6:23
  Speaker 1: So are we going to manipulate and mobilize hypermobile joints?
• 6:28
  Speaker 1: No, okay, they're already moving enough, they're already.
• 6:32
  Speaker 1: You're actually I'm maybe unstable Okay, we need to mobilize the ones that aren't moving well enough.
• 6:36
  Speaker 1: And those are the ones that usually neighbor it, that contribute to whatever your athletic move is for throwing, for running, for swimming, volleyball hits, like whatever squats what other joints are required in that movement?
• 6:47
  Speaker 1: And those ones that aren't moving well enough.
• 6:50
  Speaker 1: That's where we need to intervene with our manual therapy and mobility okay, manipulations and joint mobilizations and then work on soft tissue restrictions.
• 6:57
  Speaker 1: Does that make sense?
• 6:58
  Speaker 1: And the last component is dynamic stability.
• 7:01
  Speaker 1: We have to fix the movement, coordination and control of these joints and your limb, all these body parts that contribute to this athletic move and active movement.
• 7:10
  Speaker 1: Okay, and that dynamic stability, right.
• 7:13
  Speaker 1: We have to fix that mechanical flaw, the biomechanical flaw that otherwise is going to cause the hypermobile joint and the over-recruited muscle to get overwhelmed all the time that tissue is going to get lit up.
• 7:24
  Speaker 1: It's doing too much and it's trying to hang on for dear life, but it can't, and so it's failing at this point.
• 7:29
  Speaker 1: So, with that being said, if that's the cause of the problem, will an injection fix that?
• 7:34
  Speaker 1: Unfortunately, no.
• 7:36
  Speaker 1: It's going to make things feel better Totally, and if somebody needs I don't hate injections If somebody with the right mindset going into them.
• 7:43
  Speaker 1: They're not a solution, they're just to get things to decrease inflammation and pain real quick, right away, to get things feeling better so that someone can live their life and not be in agony, right?
• 7:53
  Speaker 1: Or if an athlete has, like a playoff game tomorrow and they have, they need to play and their season is about to end, otherwise, right, that's.
• 8:00
  Speaker 1: That's where someone needs to make a decision of like do I just do an injection?
• 8:03
  Speaker 1: I can be pain-free real quick and then handle it.
• 8:06
  Speaker 1: But then usually afterwards it's like man, my ankle hurts terribly, or my knee was like really bad.
• 8:11
  Speaker 1: There's a consequence that comes with that, of course, if you just power through and play and when you're numbed up.
• 8:16
  Speaker 1: There's been several pro NFL football players I've talked with that said the same thing.
• 8:21
  Speaker 1: We're like man, my knee felt great before games.
• 8:23
  Speaker 1: Then it definitely felt a lot worse the next day.
• 8:26
  Speaker 1: So solution work through some stuff, take some anti-inflammatories for the next week and then get another injection pre-game the next week Feels great.
• 8:36
  Speaker 1: Then it hurts even worse.
• 8:38
  Speaker 1: Same process Get some treatment with anti-inflammatory meds and then another injection the next week.
• 8:46
  Speaker 1: It's a bummer, but I mean it's honest, I can, I get it Cause I was a high, I like to call myself a high level athlete.
• 8:52
  Speaker 1: Back in the day, back in the glory days, I get it Like you want to.
• 8:56
  Speaker 1: You need to play right.
• 8:57
  Speaker 1: The number one factor for an athlete to be effective and produce and their value is being able to play, their playing time, their durability.
• 9:06
  Speaker 1: Can you just get back on the field or the court right, or in the pool or on the tennis court, on the golf course, whatever?
• 9:11
  Speaker 1: You need to get out there and play Otherwise like you're not able to showcase yourself, you're not producing, you can't do anything right, you're not actually playing.
• 9:19
  Speaker 1: So playing time and the durability, therefore, is the number one value for an athlete.
• 9:24
  Speaker 1: But anyway.
• 9:25
  Speaker 1: So, with that being said, different approach, let's figure out why this tendon got a lip in the first place, for this insertional tendonitis.
• 9:37
  Speaker 1: So what we got to do.
• 9:38
  Speaker 1: Here's what we got to do.
• 9:39
  Speaker 1: Here's what we got to do.
• 9:40
  Speaker 1: To fix tendonitis, we have to improve the mobility disparities, the range of motion and mobility disparities of lack of mobility or hypermobility in the neighboring joints.
• 9:46
  Speaker 1: We have to identify what those are and then intervene appropriately.
• 9:48
  Speaker 1: All right, with joint mobility work, mobilizations and manipulations as appropriate and necessary.
• 9:54
  Speaker 1: And then, surrounding soft tissue restrictions, there's soft tissue that can restrict the motion too and create and contribute to the hypomobility of these joints.
• 10:02
  Speaker 1: Right, so the soft tissue around there, we can work the soft tissue.
• 10:07
  Speaker 1: We got to do soft tissue work.
• 10:08
  Speaker 1: We definitely need to.
• 10:09
  Speaker 1: You can't neglect that.
• 10:11
  Speaker 1: Scraping, like Graston as an example, a tissue assisted scraping, stripping, is usually our go-to.
• 10:17
  Speaker 1: It doesn't really feel good, but we know that active people and athletes want results.
• 10:20
  Speaker 1: They don't want treatment, they want like results.
• 10:23
  Speaker 1: All right.
• 10:23
  Speaker 1: So it's just pain with a, it's just discomfort.
• 10:26
  Speaker 1: Right With a purpose Cause we know it's going to fix something.
• 10:31
  Speaker 1: Um, cupping, I love cupping, I'm a huge cupping fan.
• 10:32
  Speaker 1: All right, it lifts and separates the tissue, breaks up adhesions, develops um, better fiber gliding so things would be more parallel and also brings blood flow and breaks up capillaries for better, uh, blood flow and nutrients delivering.
• 10:43
  Speaker 1: Um.
• 10:49
  Speaker 1: And then the last thing is dry needling.
• 10:51
  Speaker 1: Dry needling can be really effective to help with soft tissue restrictions too by decreasing acetylcholine reuptake and help with muscle relaxation.
• 10:55
  Speaker 1: It also helps to break up knots like tissue adhesions and lay down new fibroblast tissue for angiogenesis development of collagen.
• 11:04
  Speaker 1: But anyway, I'll get into that in a second.
• 11:06
  Speaker 1: So we have to improve joint mobility disparities, all those factors, and manual therapy is what that is.
• 11:12
  Speaker 1: We have to do manual therapy.
• 11:13
  Speaker 1: It really sets things up for success for the joints to move better.
• 11:21
  Speaker 1: Unfortunately, joint play and some of the joint mobility can't be fixed with exercise alone.
• 11:26
  Speaker 1: We have to intervene manually.
• 11:28
  Speaker 1: There has to be an external force that intervenes to improve and fix those mobility disparities and that's manual therapy.
• 11:36
  Speaker 1: So we are huge manual therapy advocates.
• 11:39
  Speaker 1: Athletes and active people need manual therapy to set the joints up for success and address those compensation patterns in the joint range of motion and mobility.
• 11:48
  Speaker 1: Okay.
• 11:49
  Speaker 1: So once we improve the joint mobility, compensatory mobility issues in a specific, directly targeted way right, this is purposeful discretion Then we can implement the corrective exercises and that's where we fix the compensational movement pattern dysfunctions.
• 12:04
  Speaker 1: Okay, and muscle recruitment disparities.
• 12:07
  Speaker 1: We have to get the muscles to recruit around it, the other muscles that contribute to this action that you do for tennis or golf.
• 12:13
  Speaker 1: There's other muscles required.
• 12:14
  Speaker 1: As an example, for the elbow there's usually a link in the scapula in the shoulder of like an issue, a compensation pattern, a lack of scapular stability right, or rotator cuff activation, rotator cuff strength and stability right or rotator cuff activation, rotator cuff strength and stability, stabilizing the shoulder joint.
• 12:27
  Speaker 1: There's usually a link with that for LO that we're finding All right but anyway.
• 12:30
  Speaker 1: So we have to address that.
• 12:32
  Speaker 1: It's contributing to the movement of your athletics and that's making that tendon get overwhelmed.
• 12:36
  Speaker 1: So corrective exercise implementation by fixing the recruitment, compensation issues and strength issues and dynamic stability issues, which is like a movement control and coordination problem.
• 12:48
  Speaker 1: All right, if somebody is moving and diving into not the best learned movement pattern, we have to fix that learned movement pattern.
• 12:55
  Speaker 1: It's unlearn some things and learn new things, and that ultimately fix will fix the dynamic stability issues with the corrective exercises.
• 13:04
  Speaker 1: So the manual therapy in the, in the mobility work, sets things up for success so they can move better.
• 13:08
  Speaker 1: Now that they're moving better, let's solidify and solve the problem with corrective exercise.
• 13:13
  Speaker 1: Okay, that's what we had to do, all right.
• 13:15
  Speaker 1: So then now the things are moving better and they actually solidifies the movement patterns, improving the dynamic stability and enable the muscles to tolerate and handle the load better.
• 13:26
  Speaker 1: Okay, that's when it's called.
• 13:27
  Speaker 1: We go into load reintroduction.
• 13:30
  Speaker 1: Okay, load training as in.
• 13:32
  Speaker 1: Like, if somebody has knee tendonitis, we're not going to be able to squat 400 pounds that day, right, the tendon would get overloaded and overwhelmed.
• 13:41
  Speaker 1: We don't want to light things up over and over again.
• 13:43
  Speaker 1: Okay, and that's the third point I'm going to say in a sec, we have to, um, progressively load things to a good tolerance level and not light stuff up.
• 13:53
  Speaker 1: So when somebody leaves uh, on a point, a session with us and our appointment, um, work with us, the goal is for them to leave feeling better than when they came in, versus like just doing it anyway.
• 14:04
  Speaker 1: Right, it's too much load for the tissue right now to handle.
• 14:07
  Speaker 1: And if you can do it but it hurts, is that ultimately going to help?
• 14:12
  Speaker 1: It's going to light stuff up and it's going to take two steps back.
• 14:15
  Speaker 1: We take one step forward and we do too much and get too aggressive.
• 14:19
  Speaker 1: Take two steps back.
• 14:20
  Speaker 1: That's going to be a stalemate.
• 14:21
  Speaker 1: It's going to be frustrating and difficult for everybody.
• 14:23
  Speaker 1: It's going to be frustrating, wasted money and time for everybody, all right.
• 14:26
  Speaker 1: So, um, heating the advice that we're suggesting it's like don't do too much too quick, right With a load it progressively.
• 14:34
  Speaker 1: And eccentrics is a great way to work on that in a non irritating, non painful way to help lay down new collagen.
• 14:41
  Speaker 1: Um, integrity of the tendon improve the integrity, tensile strength of the tendon.
• 14:46
  Speaker 1: Eccentric strengthening is a great avenue to do that, according to the research, and one of the main things is not creating more pain and irritation.
• 14:53
  Speaker 1: So, like I said, if somebody ever hurts, we have to change it.
• 14:57
  Speaker 1: If it causes pain, we gotta fix it, we gotta change it up.
• 15:01
  Speaker 1: If the pain comes back later that day or that night or the next day, then we gotta course correct right.
• 15:07
  Speaker 1: So we always ask him for this feedback How'd you feel when you leave?
• 15:13
  Speaker 1: How'd you feel that night?
• 15:13
  Speaker 1: How'd you feel the next morning?
• 15:14
  Speaker 1: How'd you feel that day, the next day, today, upon arrival, how do you feel, right, like well, it does hurt a little bit.
• 15:17
  Speaker 1: What'd you do?
• 15:17
  Speaker 1: Oh, I didn't do anything.
• 15:18
  Speaker 1: What'd you do?
• 15:20
  Speaker 1: Well, I did do this and I was like well, that might be too.
• 15:34
  Speaker 1: If you want to see results, we have to be pretty vigilant and aware of what things are causing issues and we can't light it up over and over again.
• 15:39
  Speaker 1: Anyway, with that being said, we have to improve the dynamic stability and then load it appropriately and progressively, and eccentrics is a great way to help intervene and add in and implement.
• 15:45
  Speaker 1: The other thing on top of that is BFR blood flow restriction All right.
• 15:50
  Speaker 1: So for tendonitis, we can load it with eccentrics and then we can also load it in a very small way while it's restricted in its blood, while it's restricted in its blood flow and that has been found in the research to really help improve strength gains without actually having to load it a ton of weight, all right.
• 16:04
  Speaker 1: So, as an example, for ACL repair right, or someone with knee tendonitis right, we can apply a blood restriction, blood flow restriction cuff around their femoral artery on the top of their thigh and it feels really tight and it restricts blood flow down the rest of the leg.
• 16:20
  Speaker 1: And while it's in that state, you exercise it.
• 16:23
  Speaker 1: All right, you load it, you purposely put strain through the tendons and the muscles and the joints, but not a lot is required, which is great, because that means we don't have to overload the tissue to actually get the strength gains, as if you were so.
• 16:38
  Speaker 1: It's really cool.
• 16:38
  Speaker 1: You can load it at a very small rate that it can tolerate but the body reacts in a way as if you did load it with like 300 pounds.
• 16:45
  Speaker 1: It's really cool.
• 16:46
  Speaker 1: It kind of tricks your body to react in a certain way.
• 16:49
  Speaker 1: There's a neural, neurological response and an endocrine response that helps to with those changes, with that benefit of strength improvements, which is cool.
• 16:58
  Speaker 1: Dry needling is really helpful, like I was mentioning.
• 17:02
  Speaker 1: I want to get and dive into that a little bit for insertional tendonitis.
• 17:05
  Speaker 1: It helps to stimulate fibroblast activity to lay down new collagen fibers.
• 17:09
  Speaker 1: It helps to stimulate the healing response and improve tendon integrity.
• 17:13
  Speaker 1: It creates angiogenesis, which is development of new blood capillaries and blood vessels around the area for new blood flow and stimulate blood activity for nutrients and oxygen delivery.
• 17:24
  Speaker 1: It helps to recruit endogenous opioids for symptom relief Endogenous being like your own self-natural opioids and it helps for just making things feel better.
• 17:34
  Speaker 1: And then adding the electrical stim on top of that from the research that's describing, the electrical stim helps to amplify those effects.
• 17:43
  Speaker 1: So we'll put electrical stim on while the needles are inside someone's muscles or tendons and the joint spaces and it helps to amplify the effects of those benefits I just described.
• 17:53
  Speaker 1: But the number one thing overall for insertional tendonitis and somebody battling tendonitis issues is don't F it up over and over again.
• 18:00
  Speaker 1: Okay, this is the hardest part, especially for active, driven people that are like I want to get after it, I'm getting cabin fever.
• 18:06
  Speaker 1: I'm tired of just resting.
• 18:07
  Speaker 1: First of all, don't rest, just modify.
• 18:10
  Speaker 1: We're going to modify your activities.
• 18:11
  Speaker 1: Don't do this, do that.
• 18:13
  Speaker 1: Okay.
• 18:13
  Speaker 1: What can I do, what can I not do?
• 18:14
  Speaker 1: Your symptoms will tell you, okay.
• 18:16
  Speaker 1: So be aware and mindful of your body.
• 18:18
  Speaker 1: Your body's going to tell you if it hurts when you're doing this.
• 18:21
  Speaker 1: It might or change the volume, all right, just do less, just modify a little bit so that when you're doing it doesn't hurt.
• 18:31
  Speaker 1: After you're done doing it doesn't hurt worse.
• 18:33
  Speaker 1: The next day it doesn't hurt worse, perfect, all right.
• 18:36
  Speaker 1: That's where we want to stay at and that's going to change day to day.
• 18:39
  Speaker 1: So, being mindful and riding that roller coaster hopefully it's not a huge dramatic roller coaster and there is a reason.
• 18:44
  Speaker 1: Usually people are doing too much too fast but maybe a small road because there's gonna be good days and bad days.
• 18:48
  Speaker 1: But a small roller coaster and over the period of several weeks, that's we have a positive trend and you have improvements and then you're back to doing the thing that you want to do without pain.
• 18:55
  Speaker 1: Boom, that's a win-win.
• 18:56
  Speaker 1: But it can't be.
• 18:57
  Speaker 1: We can't cut corners or skip steps.
• 19:00
  Speaker 1: If that makes sense, um, but anyway, we can't F it up over and over again.
• 19:04
  Speaker 1: We have to stop the bleeding, metaphorically, and we have to get things to settle down.
• 19:09
  Speaker 1: Okay, so we have to allow things to settle down.
• 19:11
  Speaker 1: And a huge another aspect just modifying your activity, but the other huge aspect is sleep posture.
• 19:18
  Speaker 1: We can't neglect sleeping position, prolonged positions, work posture, driving posture, eating posture, watching TV posture and sleep posture.
• 19:27
  Speaker 1: Sleep is the first thing we talk about with all our patients.
• 19:29
  Speaker 1: The position that you put yourself in can set things up for irritation and it allows it to maybe to not be in an advantageous position to heal and recover, because healing and recovery is the main goal for sleep.
• 19:40
  Speaker 1: Of course, if we're putting ourselves in positions that don't really allow and facilitate that, we're actually hindering the healing potential and maybe even actually contributing to more irritation, which is no bueno right.
• 19:51
  Speaker 1: So being mindful of sleep posture is a game changer.
• 19:55
  Speaker 1: We talk about that with all our patients right away, because very often people will come in and be like it still hurts.
• 20:01
  Speaker 1: I just woke up and my knee hurts.
• 20:02
  Speaker 1: What'd you do?
• 20:04
  Speaker 1: Oh, I just slept.
• 20:05
  Speaker 1: How about the night before?
• 20:06
  Speaker 1: How did it feel before you went to bed that night?
• 20:09
  Speaker 1: It was fine, I was just doing homework, right.
• 20:11
  Speaker 1: Or I was just like watching TV with my, with my kiddos.
• 20:13
  Speaker 1: Um, what about earlier that day?
• 20:15
  Speaker 1: What'd you do?
• 20:16
  Speaker 1: I just rested, right.
• 20:17
  Speaker 1: I did everything.
• 20:18
  Speaker 1: The doc told me, the orthopedic.
• 20:19
  Speaker 1: They were like just rest and take Advil.
• 20:21
  Speaker 1: It's like, okay, that's not going to be huge.
• 20:32
  Speaker 1: Like there's other things we can implement.
• 20:33
  Speaker 1: Um, that's not going to solve any problems, like we've talked about at length.
• 20:34
  Speaker 1: Um, and there's a time and place for that stuff, but in this, in non-traumatic, chronic issues of movement disparity issues, that's not going to solve those movement disparity issues.
• 20:40
  Speaker 1: So, anyway, they're like yeah, it didn't do anything and it hurts.
• 20:43
  Speaker 1: Woke up this morning.
• 20:44
  Speaker 1: Hurts hurts.
• 20:45
  Speaker 1: Reason does.
• 20:46
  Speaker 1: I'm an anomaly, doesn't make sense.
• 20:48
  Speaker 1: What position did you sleep at?
• 20:50
  Speaker 1: So you went to bed feeling Okay.
• 20:51
  Speaker 1: That day before you didn't do anything to provoke it.
• 20:53
  Speaker 1: Went to bed feel fine, woke up this morning and it hurts.
• 20:56
  Speaker 1: So the only thing you did in between was sleep.
• 21:00
  Speaker 1: What position did you sleep in?
• 21:01
  Speaker 1: Well, I slept on my stomach, okay how, with my neck rotated all the way 90 degrees and my shoulder up.
• 21:08
  Speaker 1: It's like and your neck hurts today, right, or your shoulder, your rotator cuff, your shoulder hurts this morning.
• 21:12
  Speaker 1: It's like there is a correlation here, like your position in your sleep is definitely can affect and irritate stuff or set it up for failure, unfortunately.
• 21:19
  Speaker 1: So sleep position hurts right, or my knee hurts right.
• 21:23
  Speaker 1: And they slept in the fetal position all night with their knees fully flexed, fully bent, and then when they wake up and they extend their knee, it's like, oh, it hurts right, it was just hyper-stretched all night, right, and a tissue like your patellar tendon that gets overloaded and overwhelmed can chronically get overstretched right and it gets lit up and irritated and it's overwhelmed.
• 21:42
  Speaker 1: Imagine doing a quad stretch with your knee to your butt all night for eight hours, not moving right.
• 21:49
  Speaker 1: It's maintained in that hyperflexed, full flexion position for a long, many, many hours.
• 21:54
  Speaker 1: Do you think when you straighten it it's going to feel great?
• 21:57
  Speaker 1: Probably not.
• 21:58
  Speaker 1: It's overwhelmed.
• 21:59
  Speaker 1: It just contributed to its irritation, right.
• 22:01
  Speaker 1: So we have to be mindful and aware of that.
• 22:03
  Speaker 1: It's just one contributing factor.
• 22:05
  Speaker 1: That's a very influential contributing factor that sets the whole stage for things to not get better for no reason, right, it just plays a role, all right.
• 22:15
  Speaker 1: So all of this collectively is what ultimately creates lasting results and decreases the risks of this issue returning and actually solves the underlying problem.
• 22:23
  Speaker 1: All right.
• 22:23
  Speaker 1: So a big, huge component of this is education and also lowering the risk of these things coming back in the future.
• 22:29
  Speaker 1: What's preventing it from happening again?
• 22:31
  Speaker 1: Fixing the actual underlying cause of the problem, which is usually the mobility disparities, muscle recruitment, dynamic stability and movement flaw problems.
• 22:39
  Speaker 1: That all collectively is usually what brings things about like this.
• 22:44
  Speaker 1: Adding in sleep, posture, mobility, soft tissue work, not effing it up over and over again.
• 22:51
  Speaker 1: Those are all the things that collectively can help solve this problem, prevent it from coming back again.
• 22:58
  Speaker 1: It's interesting, though, talking about this movement pattern stuff, right, so movement system dysfunctions is a collective amount of all the joints that surround and all the muscle tissue and all the recruitment disparities, and all those things contribute the way that person moves and grooves with not the best dynamic stability or control, not the best coordination through the movement and overloading the tissue right, all those things that we would call that a movement system impairment or movement system dysfunction, and particularly in athletes and active people, that's people that, um it just.
• 23:34
  Speaker 1: My pain came out of nowhere, like it just started hurting.
• 23:36
  Speaker 1: My shoulder started hurting for no reason three months ago.
• 23:39
  Speaker 1: But those learned movement patterns over several years get reinforced over and over with every single rep.
• 23:46
  Speaker 1: From a young child to adolescence, into early adulthood, into adulthood, those learned movement patterns develop and those get reinforced with every rep over and over again.
• 23:58
  Speaker 1: And so it's like how does this even start?
• 24:00
  Speaker 1: Man, I don't know, right Beyond me, probably when they were a kid, they just learned how to move a certain way and they were predisposed and set up within those movement patterns to then develop these issues later, years later, because these movement patterns were reinforced and always recalibrated constantly and it just overloaded the same tissue over and over and over again.
• 24:20
  Speaker 1: That no one's going to go to a physical therapist and say like, hey, how's my running form?
• 24:23
  Speaker 1: Am I doing any movement system impairments?
• 24:25
  Speaker 1: You know what I mean.
• 24:25
  Speaker 1: So no one's going to really dive into this until they actually have symptoms and it's like, how did this start in the first place?
• 24:30
  Speaker 1: This is really what we would consider to be the answer.
• 24:32
  Speaker 1: It's a movement system impairment.
• 24:34
  Speaker 1: So these learned movement patterns sometimes it's hard that's been ingrained for years is very difficult to unlearn, right, it's more difficult to unlearn something that's ingrained than it is to learn something new, most of the time for these active people and athletes.
• 24:51
  Speaker 1: So that's why it takes a little bit of time to educate and just work through this stuff.
• 24:54
  Speaker 1: So it's interesting that what I did not mention in this conversation.
• 25:01
  Speaker 1: The question is I have tendonitis, insertional tendonitis how do I fix it?
• 25:06
  Speaker 1: Right, what we did not talk about as a game-changing implementation intervention is ice Interesting, right.
• 25:17
  Speaker 1: Unfortunately, heat or ice, the validity behind what it's purported to do in the research is pretty weak.
• 25:24
  Speaker 1: Okay, the evidence is pretty weak to support that it does what it's actually purported to do, which is decrease inflammation.
• 25:32
  Speaker 1: Right, that's what the whole thought is around the public.
• 25:35
  Speaker 1: It's like oh, ice it, it's going to decrease inflammation.
• 25:37
  Speaker 1: It's not going to get inflammation that's currently in there out.
• 25:40
  Speaker 1: Okay, it's a constrictor no-transcript.
• 25:57
  Speaker 1: So what they suggest is like after 48 to 72 hours of an injury, ice really isn't as effective in preventing more inflammation from getting in there.
• 26:05
  Speaker 1: That's already happened.
• 26:05
  Speaker 1: That's too late, right?
• 26:07
  Speaker 1: So icing it for no reason, is not really going to help prevent getting inflammation out.
• 26:11
  Speaker 1: Okay.
• 26:12
  Speaker 1: And then heat same thought is uh, it's supposed to be a dilator, it could be good for symptom relief, but it's not.
• 26:19
  Speaker 1: It's not really going to help with joint mobility.
• 26:22
  Speaker 1: All right, and warming things up.
• 26:23
  Speaker 1: The best thing to warm things up is actually moving, and moving it, just not in a painful way.
• 26:27
  Speaker 1: But so the first question we ask with this is like do you enjoy ice?
• 26:31
  Speaker 1: Do you like it or do you like heat?
• 26:33
  Speaker 1: Do you think it helps you?
• 26:34
  Speaker 1: That's the number one factor that we'll ask Okay, then do it, it's not going to kill you.
• 26:39
  Speaker 1: We're not going to prioritize it or emphasize it because it's not going to solve your underlying problem.
• 26:43
  Speaker 1: So, to summarize this real quick somebody comes in with tendonitis.
• 26:47
  Speaker 1: What do you do?
• 26:48
  Speaker 1: Insertional tendonitis how can we fix this tendonitis?
• 26:50
  Speaker 1: Well, number one, coming from a mindset that it happened because of an overload, overuse.
• 26:55
  Speaker 1: That's not overuse, it's overloaded with poor mechanics over a long period of time.
• 27:00
  Speaker 1: Right, overloaded with poor mechanics.
• 27:03
  Speaker 1: So that's a mobility disparity, muscle recruitment, strength, dynamic stability, movement system problem.
• 27:09
  Speaker 1: Okay, and that's what we have to come from it as.
• 27:11
  Speaker 1: So how do we treat it?
• 27:12
  Speaker 1: Well, we got to fix the joint range of motion mobility disparities.
• 27:16
  Speaker 1: With joint mobility.
• 27:17
  Speaker 1: We have to fix the soft tissue restrictions around it.
• 27:19
  Speaker 1: We can address the actual tendon itself with dry needling, cupping to stimulate healing response of all the things we talked in the past.
• 27:25
  Speaker 1: Then we have to load and strengthen things and fix the actual movement disparity problems, okay, the movement coordination problems, loading it with BFR, blood flow restriction and also eccentrics and then also fixing the movement patterns.
• 27:40
  Speaker 1: That's what we have to work on.
• 27:42
  Speaker 1: And the number one thing overall is just don't chronically F it up over and over again.
• 27:45
  Speaker 1: Don't make it worse again and again and again and again.
• 27:49
  Speaker 1: That's a great way to allow things to linger.
• 27:51
  Speaker 1: Okay, so, with athletes that we worked with and active people, the issue with tendonitis is it lingers forever.
• 27:56
  Speaker 1: It's just not getting better.
• 27:57
  Speaker 1: It lingers.
• 27:58
  Speaker 1: The lingering comes from not fixing things we talked about and then also constantly just effing it up, constantly just irritating it a little bit.
• 28:07
  Speaker 1: That allows a hypervigilant tissue and the nerves that are in there too, that are hypervigilant and sensitive, um to to really getting irritated again easily.
• 28:17
  Speaker 1: Right, so that's the main problem.
• 28:20
  Speaker 1: And, uh, the number one thing we find with active patients is going back into things too much too quickly because usually they feel pretty good after a couple of sessions and then they dive into it too much quick and that lights it up okay and it makes things worse.
• 28:36
  Speaker 1: So doing too much too fast can definitely set it up for failure.
• 28:41
  Speaker 1: So it's like, hey, hang on, be mindful of your activity, like what you're doing, if it causes symptoms, and back it up a little bit.
• 28:47
  Speaker 1: We don't want to just power through because they're going to take five steps backwards again and we're starting everyone and everybody's frustrated, right, everybody's frustrated and it's a waste of money and time for everybody.
• 28:57
  Speaker 1: So not doing too much too quickly is the hardest part for athletes and active people and I totally get it.
• 29:02
  Speaker 1: I've been in that boat too.
• 29:03
  Speaker 1: So if you have any questions about this, about your own 10 and 90s you've been battling, or why it happened in the first place or how we can treat it, definitely reach out.
• 29:10
  Speaker 1: We'd love to talk with you.
• 29:11
  Speaker 1: You can reach us best at 561-899-8725 is our phone number, or our administrative email, which is team at athlete rccom, cause we'd love to chat with you and help you, cause, like I said, we live vicariously through our patients and we know that this has been an issue for us.
• 29:27
  Speaker 1: This is a huge common issue for athletes and active people that we've battled ourselves in the past and that we're passionate about.
• 29:31
  Speaker 1: And we just nerd out on this stuff because we live vicariously through our patients.
• 29:35
  Speaker 1: So we're just passionate about this stuff.
• 29:37
  Speaker 1: We want to help you.
• 29:37
  Speaker 1: There is a solution, all right.
• 29:39
  Speaker 1: We do this very often and all the time, so we want to bring hope to people that it can be solved.
• 29:43
  Speaker 1: So definitely don't hesitate to reach out.
• 29:45
  Speaker 1: We'd love to talk to you and we'll catch y'all next time.