re­hab Tri Train­ing Through Ten­don In­juries

Triathlon Magazine Canada - - Contents Volume 8 Issue 6 -

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

By Greg Lehman

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