How a strong alliance between your physio and PT can help you and your tendon
A common frustration personal trainers have working with physiotherapists
Last week I presented a 75 minute professional development session to a group of personal trainers. The topic was all things relating to tendon injury management. I found it to be such a beneficial session for myself (as well as hopefully the PT’s) as it gave me an idea of the difficulties PT’s have with diagnosing medical stuff as they attempt to guide a client to his/her goals.
Personal Trainers are a great resource available to us at most commercial gyms. They exist to help us set goals, motivate, educate, coach and facilitate you on your health and fitness. Your PT will most likely guide you through a process of setting a goal (unless you really didn’t want to), this process helps determine what they need you to do, to help get you get to that point.
One of the biggest frustrations that PT’s have is that physiotherapists and doctors are often telling their clients to stay away from the gym. When a client drops out or pauses their PT program, it will usually mean that they won’t reach their goal. Sometimes it is necessary for a person to avoid the gym, however, usually exercise alternatives can be found to help work around the impairment/injury.
One of the biggest frustrations that PT’s have is that physiotherapists and doctors are often telling their clients to stay away from the gym. #performbetter @pogophysio Click To TweetCase Study
(It is common for medical educators to use a case study so that we can apply what we learn into a real life situation)
I tried to best represent a common client that would present to a PT:
Jessica is a 34 year old female wants to lose 10kgs in 6 months before a wedding. She hasn’t been doing much exercise as she has had 3 children and has been very busy, she used to run but has not done so for 10 years. In her fifth week of exercise she is on track for achieving her weight loss goals however she develops a painful achilles tendon after going for her 3rd run in one week having also done 10 mins of skipping that morning with her PT. Her achilles pain settles within one day but it returns every time she goes for a run and worsens to the point that, in the 10th week of training she can no longer run. She is scared that she will snap her achilles tendon as the nurse she used to work with did so stepping down two stairs and she had to have surgery and a long time off of work. How can we help Jessica?
Jessica’s PT helps her to understand that she needs to seek help:
If your PT can help to guide you down the most effective path then they are helping you to reach your goals quicker. Your PT can help to locate your pain and give you advice on whom to seek help from, hopefully, in this case, a physiotherapist!
If your PT can help to guide you down the most effective path then they are helping you to reach your goals quicker. #performbetter @pogophysio Click To TweetGive Jessica an accurate diagnosis:
We love tendon management! So we are 100% confident we will take the time necessary to use our honed clinical knowledge to find out and explain exactly why Jessica is experiencing achilles pain.
In this case, Jessica has irritable mid portion achilles tendinopathy in the early degenerative phase of the tendon continuum, previously referred to here>>> My Preferred clinical tendon classification system
Jessica also has a weak hamstring and calf on her affected side, this means she cannot hop as far on her sore leg nor can she propel sufficiently from it when she is running.
Early management:
Initially, Jessica needs some treatment to help settle her irritable pain. This could include an array of pain modulating options such as icing of the tendon, massage to adjoining muscle, ShockWave Therapy of the tendon etc.
It would also usually include gentle isometric exercises. These are static exercises which actually help to relieve pain in tendons, so when prescribed correctly, it’s almost like taking a panadol for your painful tendon. You can read more about it here>>>Isometric tendon exercise
I would prescribe Jessica a 40 second static calf raise with heel one inch above the ground, repeated 4 times with at least 30 sec rest in between.
During the period of early management where calming down the pain from Jessica’s tendon while not aggravating it by completing more running or hopping activities, there is still plenty that she can do to make sure she achieves her weight loss goals!
With good communication I would advise Jessica’s PT that there should be no jumping or on toes activities, however, Jessica can participate in any weights sessions or cardio activities that are off legs eg cycling, battle ropes, med ball slams. Jessica can also start isolated strengthening of the muscle groups below and above the painful area, in this case, her hamstring. Her PT could be an excellent asset in supervising strengthening if they are communicated with.
Next Phase:
The key to tendon rehabilitation is appropriate loading via strength exercises.
The key to tendon rehabilitation is appropriate loading via strength exercises. #performbetter @pogophysio Click To TweetOnce the pain has settled enough Jessica should be starting Heavy, Slow Resistance Exercises, explained in more detail here>>>
I would advise Jessica to complete 4 sets of 12 reps every second day with an appropriate weight (progressing over time), making sure adequate rest periods are allowed, ie there is no harm in having two days of rest between bouts of exercise if there is soreness. Tendon rehab usually takes no less than 6 weeks, so there is plenty to continue with during the rehab!
Jessica’s gradual increase and loading and slow return to activity (running in this case) should not affect her ability to achieve her weight loss goals! Her well informed PT and physio should regularly trade information on progress so that they can help each other to achieve her long term goals.
Her physio will diagnose, treat pain, set stages for rehabiltation and advise suitable/unsuitable exercises while her PT can supervise rehab, train adjacent muscle groups and use their knowledge to continue training while not aggravating her pain.
If you are working towards athletic/body composition or general health and fitness goals but encounter an injury which threatens to halt your progress, we love to help people out of these situations! As always, our main aim would be to see Jessica cross her physio finish line, and return to full training and running.
Michael Harders
Master Physiotherapist
Featured in the Top 50 Physical Therapy Blog
