rehab Tri Training Through Tendon Injuries
Doyou have an old injury that never really seems to go away? Perhaps you can still run, bike and swim, but feel that injury has created a lasting imbalance? If you’ve ever had a tendon injury, you likely rested it, did some good rehab and then got right back to racing. But you may have been missing the final component of rehabilitation that cranky and injured tendons crave – heavy and varied resistance training.
Tendons are resilient springs. They respond well to the loads and stresses we place on them. Stressing a tendon with physical loading is the means to creating adaptation. It is the catalyst for healing and tissue growth. Rehabilitation requires finding the right amount of stress (e. g. exercise, weightlifting, jump training and sometimes rest) for the tendon at the right time. Unfortunately, most of us stop too soon with our rehabilitation and never stress the tendon enough for it to adapt back to its pre-injury status.
Examples of persisting tendon problems include nagging pain in the upper thigh where the hamstring inserts into the glute, Achilles tendon pain, “shin splints,” patellar tendon pain or even a shoulder that is just not what it once was. What these tendons need is a reason to adapt. We need to find the exercise stimulus that has been lacking, load the tendon and wait for the tendon to get to 100 per cent and beyond.
For the past decade daily, painful eccentric loading (for example an exercise where the muscle lengthens as we stress it) has dominated how we treat tendons. However, recent research by Denmark-based tendon researcher Dr. Kongsgaard has shown that heavy resistance training (e. g. squats, leg press and hack squat) might be the more effective treatment plan. When compared with Corticosteroid injections and standard eccentric training, heavy resistance training demonstrates comparable short-term (12 weeks) and superior long-term (six months) outcomes when measuring pain, satisfaction and the actual physical structure of the tendon. In very simple terms, the heavy resistance training seems to provide a superior stimulus to cause the tendon to adapt and become a more “normal” tendon.
Another exercise component that is often missing in tendon rehabilitation is explosive/plyometric training. This is an advanced training technique that places high loads on the tendon. Although not a popular belief, explosive power is a physical trait that multisport athletes need. Not only is plyometric training excellent for rehabilitation, it also provides performance benefits. We have strong evidence that plyometric training increases mechanical efficiency during running as well as improving the neuromuscular “wonkiness” that many athletes experience during the transition from the bike to the run.
The specific details of a heavy resistance or plyometric program is athlete dependent. Those with no background in resistance training would see benefits following two exercise sessions a week. These would consist of one to two sets (five to 10 repetitions) of two to three different exercises targeting a particular tendon. Many exercises can be used, provided they target the specific tendon and train the muscle-tendon at a high level of force. Those with a background in resistance training would be able to handle more sets (three to four) per exercise.
If you have high hamstring tendon pain you might benefit from heavy hip thruster exercises, Nordic hamstring curls or oneleg deadlifts. Those with knee tendon pain can benefit from deep squats, split squats or heavy one-legged squats. Achilles tendon problems can respond to heavy one-legged calf raises and plyometric jumping exercises.
Tendons are strong and take a long time to adapt and change. But they also need a reason to do so. Adding different stresses than what your usual conditioning program provides may be the final physical stimulus that your cranky tendons need to fully heal. As with all medical advice, please consult with a trained professional to determine if this is an appropriate training stimulus for you and to fit heavy resistance and plyometric exercises into your training program. Greg Lehman is a physiotherapist, running injury therapist and chiropractor at Urban Athlete and at Medcan in Toronto. Follow his blog at