Tendonitis: What is it and how do you deal with it?

Tendonitis is a pain..literally. The body has quite a few tendons in it and they are all susceptible to this damaging process, but it occurs in some areas significantly more often than others. What is actually going on with tendonitis though?

To put it simply, it is a chronic state of inflammation and irritation that leads to changes in the tendons of our muscles. Tendonitis is pretty much always associated with some kind of overuse and repetitive movement pattern.

Golfer’s Elbow and Tennis Elbow are named the way they are because they occur frequently in those respective sports, both of which involve repetitive motions of the forearm muscles. The tendon’s capacity gets exceeded, usually by a sudden spike in volume of activity. This causes the healing process to kick in and pain ensues.

This would be the ideal time to have a little rest, but what usually happens is that people push through and keeping using the affected tendons. This perpetuates the inflammatory phase of healing and causes the tendon to never fully heal up. So you can imagine that this would make the tendon a lot weaker over time. This then leads to even lower tissue capacity and now you’ve got a vicious cycle.

Unfortunately, rest is no longer an option at this point and it will actually make things worse. Tendonitis amounts to a load and stretch intolerance, as the tendons get weak during this process. The only way to make the physical changes needed in order to make the tendon more resilient is to load it up. This must be done gradually and in a controlled fashion. There will be some pain involved with this process, but as long as you can keep it to a 4/10 or less, its not something you should be worried about.

Slow load is the name of the game for tendonitis and tendinosis! Eccentrics are the best thing you can do for your tendons. These are movements that make you work during the “down” phase. For example, the portion of the squat in which you are descending or the portion of the overhead press where you are lowering the weight back down to your shoulder. These kinds of movements are great for strength and will cause less pain and irritation.

Load up your tendons, keep the weights lower, slow it down and keep your pain manageable. Gradually increase the weight you are lifting or the volume you are performing, only as your symptoms allow. If you get a flare up of pain, you may have done too much and it just means you need to regress back for a little bit longer. Be patient! Building up the body takes time, adequate rest and good nutrition.

Mobility Best Practices: How much should you do?

Mobility has been a buzzword for a few years now. In most people’s minds, it probably has to do with all kinds of foam rolling, massage gunning, lacrosse balls, mobility bands, static stretching, scraping, all kinds of stuff. The problem is when people exclusively rely on these passive interventions in order to improve their movement or help any pain they may be dealing with. In some cases, performing these kinds of activity too frequently or intensely can be detrimental.

Why do these things make you feel better though? All of these interventions have one thing in common, some form of deep pressure or sustained stretch on a muscle or joint. Our body was designed in a way that we have checks and balances in place to keep our tissues safe when subjected to certain forces like rapid stretch. In general, deep stretch and deep pressure will cause a muscle to relax. This is achieved by an inhibition of the nervous system structures that are a part of every muscle. So, when we foam roll etc the muscle relaxes and this usually allows for improved flexibility and decreased pain sensations.

Unfortunately these effects are almost always temporary. If we think of “tightness” or “pain” as just symptoms, which they are, then they are taking place because of a result of something else. Until the factor that is causing these symptoms is taken care of, the symptoms will almost always return after a period of time.

If you have persistent pain or flexibility issues, you should work closely with a professional to figure out what is causing these issues. Fix the problem and the symptoms will disappear. That being said, performing mobility work is not a bad thing when it is done properly and with appropriate dosage

Let’s look at a few variables to consider:

• Frequency

  • How often should you perform passive interventions such as stretching, foam rolling, etc?

  • Most people shouldn’t worry about performing these types of activities more than a 2-3 times per week

  • Hit different muscle groups. Lower body one day, upper body the next, etc.

• Duration

  • Research has shown that the relaxation effects that foam rolling, stretching, etc cause can be achieved with pretty minimal time demands.

  • Don’t worry about performing these activities for more than 90 seconds-2 minutes at a time.

  • Longer =/= Better

• Intensity

  • If you put yourself through intense discomfort with your mobility drills, you are probably doing too much. And you definitely shouldn’t be left bruised afterwards.

  • It doesn’t require near as much force as you’d think it would to achieve the effects you are after. You aren’t “breaking up scar tissue” or anything like that. Just causing the nervous system to chill out a bit and moving fluids around.

  • It should be a relaxing process, not something where you have to hold your breath and yell to get through it.

Performing mobility work is not a bad thing, but using it as a cure all for your crappy movement and pain is a bad thing. Move well, move often, train through a full range of motion, lower the weights when you are hurting and get yourself assessed by a Physical Therapist who knows what to look for.

Training while Injured: Staying Safe while Maintaining Fitness

Rest is Not the Answer:

In any sport or exercise regiment you choose to take part in, there will always be a risk for injury to occur. Sometimes these things happen because of ego lifting, sometimes they come from poor technique and sometimes s**t just happens for no reason at all. Regardless, pain sucks! It can derail your healthy lifestyle and keep you from reaching your goals.

This doesn’t have to happen though. There are several ways that you can modify your training in order to keep active while allowing your injury to recover. Some professionals will simply say “just don’t do that.” That’s not good enough anymore. Science has shown repeatedly that absolute rest during an injury is one of the last things you want to do.

There is such a thing as “safe pain.” By that I mean, a level of pain that is not considered dangerous to the tissue. A general rule of thumb to go by is to try to keep your pain levels to 4/10 or less during activity and to avoid anything that brings it up above that number. We can accomplish that by playing around with 5 factors.

Five Modifiable Factors:

Example of ways to modify range of motion

1. Range of Motion

   • This has to do with how much total motion is occurring.

   • Keep it simple. If it hurts to squat to full depth, than try to find a depth that doesn’t hurt. If it hurts to do vertical pulling, try horizontal pulling.

   • Less motion, less strain on the tissue.

2. Speed / Tempo

   • This refers to the speed of the movement you are performing.

   • In general, the faster or more explosive the movement, the more strain on the tissue.

   • Instead of a split jerk, try a push press. Instead of normal speed squats, try slow tempo squats at a lower load. Kipping pullups hurt? Bust out a band and do some strict for a while.

3. Load

   • This refers to how much weight you are moving.

   • A good strategy would be to try and find a threshold for weights that cause you pain and try to stay under those thresholds.

4. Volume

   • Volume management is huge. Most injuries in CrossFit, for example, are overuse injuries.

   • For some pain cases, their pain starts happening after fatigue sets in. For example, you may feel fine for the first couple miles of your run, but start hurting after mile three every time.

5. Type of Contraction

   • This refers to what kind of muscle contraction you are doing.

   • Concentric muscle contractions can be aggravating, for example, but you may be able to tolerate eccentric muscle contractions.

   • An example would be if you have pain with full ring dips, but you are able to perform pieces of it without pain, such as the support hold or lowering down into the dip.

Summary:

You should always try to change HOW you are doing something, before you change the activity altogether. Most pain complaints can be changed almost immediately if you can change these five factors around a bit. However, if you have been dealing with pain for over a few weeks and it’s not getting better, it’s time to get yourself checked out.

Injury Recovery: Are You Eating Enough?

What happens to calorie needs during an injury?

Let’s start with defining a few terms:

• Total daily energy expenditure (TDEE) - An estimation of how many calories you burn per day when exercise is taken into account

• Basal metabolic rate (BMR) - The number of calories required to keep your body functioning at rest

Thanks to the internet, it is easier than ever for people to calculate their daily calorie needs. For your BMR, all you need to provide is your age, sex, height and weight. This will give you a basic idea of what your body’s baseline caloric intake should look like.

For TDEE, in addition to the same information we just mentioned, you need to provide an estimate of what your daily activity level looks like. (Sedentary, Light, Moderate, Heavy or Athlete).

It makes sense that the more active we are, the more our calorie intake must increase in order to support our body. The opposite rings true as well. The more sedentary we are, the lower our TDEE. So what happens when you get injured? If an athlete is used to eating a certain amount in order to fuel themselves appropriately, then it follows that they should decrease their eating to match their activity level. This is true, to an extent.

When we are injured (specifically injuries to muscles, bones, ligaments, tendons, etc), our bodies have to repair that damage. This doesn’t come from nothing. It comes from what we take in with our eating. This means that the body’s BMR actually INCREASES during times of injury recovery. That’s because the body has to use additional resources in order to make the needed repairs.

How much should you eat?

These numbers are purely for sake of illustration. Let’s say that your BMR is 2,000 and let’s say that with your activity level, your TDEE comes out to 3,000. Well if you get injured, your first response might be to take your eating down to what you would normally eat if you weren’t exercising at all. This is a mistake. Your injury is going increase your BMR by up to 15-20%, depending on the injury. So just based off of our example numbers, you might be looking at needing to consume around 2,300 calories to account for the increased energy demands. Make sure that you prioritize adequate protein intake during this time as well, as this is the most essential building block for laying down new tissue.

However, you should always seek advice from someone licensed in nutrition before implementing any extreme changes in diet. Moral of the story, be careful not to under eat while you are recovering from an injury, even if you aren’t exercising regularly.

Sources:

Tipton, K. D. (2015). Nutritional Support for Exercise-Induced Injuries. Sports Medicine, 45(S1), 93–104. doi: 10.1007/s40279-015-0398-4

Berardi, J. M. (2018, March 28). Nutrition for Injury Recovery: Part 3. Retrieved from https://www.precisionnutrition.com/nutrition-for-injury-part-3

Injury Rates in Crossfit

Why the hate?

As a Physical Therapist, I know all too well about how the bulk of my profession feels about CrossFit. I sat through several lectures in graduate school that painted this type of training in a negative light. Then there’s the huge amount of healthcare providers out there today that are advocating for their clients to cease any kind of activities similar to CrossFit.

My experience has been that safety is completely dependent on the quality of coaching and volume management, but this can be said for literally any other sport. The main argument I have heard is that repetitive lifting from the floor and squatting is unsafe and harmful for people, as well as the high volume of overhead activities.

To play devil’s advocate, CrossFit had a rough start. It was driven into popularity by people promoting absurdly difficult workouts and pushing participants to their absolute limits. For this reason, the competitive side of CrossFit became the face of the sport and everyone began to associate it with extremely difficult and potentially dangerous training habits. In addition, the requirements to become a “coach” at a CrossFit gym were pretty much non existent at first. The quality of coaching was not very high and people got into owning gyms before they even had a clue what was going on. This is something that unfortunately still happens today even. I myself have witnessed gyms that don’t have any kind of warm up or coaching, and simply just tell people to “go” when it’s time to train.

Why do CrossFit?
When executed the right way, CrossFit is a truly amazing fitness program that can be done by any age person with safety. It teaches people how to move, how to eat, offers community and accountability, and promotes a lifestyle of wellness.

This is fitness summed up in 100 words. These statements give us a blueprint to improve overall health, transform our lives, and eliminate chronic disease.

The vast majority of healthcare spending today is spent on issues related to chronic (and preventable) disease. Diabetes, obesity, COPD, CAD, HTN, Strokes. These are all issues that are preventable. A lifetime of poor eating habits and sedentary lifestyle are what account for these things. CrossFit offers a simple, and powerfully effective cure for these things. Eat right, train smart, train hard, improve your life.

 The gym I coach for places great emphasis on quality over quantity and is quick to have people modify workouts in order to keep them safe. In addition, we take a very planned approach with our programming and seek to make sure that we are not overloading certain muscle groups or overtraining.

I am obviously biased towards CrossFit and similar forms of activity because I have experienced the benefits for myself and seen it in my clients. The reality is that injury is an inevitable thing in any exercise or sport regiment. When we choose to exercise and challenge ourselves on a daily basis, we have to be willing to accept that aches and pains will come along. 

What does the research show?
Klimek et al. published an article in 2018 in the Journal of Sports Rehabilitation (J Sport Rehabil. 2018 May 1;27(3):295-299. doi: 10.1123/jsr.2016-0040. Epub 2018 May 22.) The research design was a retrospective cohort study that reviewed any paper published in the past 10 years comparing injury rates among CrossFit participants and individuals participating in other fitness sports.

What the researchers found may be of no surprise: rates of injury among CrossFit participants were equal to or lower than those of participants in the other included sports (gymnastics, Olympic weightlifting, military conditioning, track and field, rugby, and distance running).

Another article by Hak et al. (J Strength Cond Res. 2013 Nov 22.) found that 73.5% of the 132 survey respondents experienced an injury while engaging in CrossFit. The total injury rate of 3.1/1000 hours trained during CrossFit training was similar to injury rates reported in: Olympic weightlifting, gymnastics, and rugby. Sports with higher injury rates, as per report, than CrossFit include high school football, ice hockey, and soccer.

There’s also the fact that CrossFit recently won some legal battles over some studies on injury rates where the data was falsified by those that were reporting it as significantly higher than what it actually was. Something to consider!

Summary
CrossFit is great. Is it right for everyone? Maybe not. Is it wrong for everyone? Certainly not. Choose a gym that has qualified trainers and a reputation for excellence. Use common sense. It can be done safely, as long as you approach it the right way. Healthcare providers, quit telling people to quit CrossFit.

Sources: 
-Hak et al., The nature and prevalence of injury during CrossFit training. (J Strength Cond Res. 2013 Nov 22.)
-Klimek et al., Are Injuries More Common With CrossFit Training Than Other Forms of Exercise? (J Sport Rehabil. 2018 May 1;27(3):295-299. doi: 10.1123/jsr.2016-0040. Epub 2018 May 22.)