Hi folks. Today’s blog comes on the heels of this past weekend’s Advanced Graston Technique Course. Much of what I learned I had been doing intuitively since Bastic Graston certification, but I did learn some nuggets of health wisdom that I want to share. Here are some highlights:
•Common tendon injuries, like achilles tendonitis, lateral epicondylitis (tennis elbow), medial epicondylitis (golfer’s elbow), and others are often (almost always) NOT inflammatory. So, stop using the term -itis. We’ve actually known this for years, but I’m reinforcing the knowledge now. Better terminology is -opathy, like achilles tendinopathy. Microscopic evaluation of these injures tendons does not reveal inflammation. And, in turn, we also know how these injuries heal. Most of these injures occur where the tendon attaches to bone. The sprain/tearing of the tendon is painful! In order for the body to heal, specialized cells known as fibroblasts need to repair the tendon and tendinous-periosteal areas. Unfortunately, the body tends to do this messy, rendering you with scar tissue and incomplete healing. Fortunately, Graston Technique instruments will stimulate recreation of the healing process by stimulating fibroblastic activity to help guide you through the process from inflammation, remodeling and ultimately complete repair. Further, by applying “Cold Laser” or Low Level Laser Therapy we ensure that the repairing tendon is as scar tissue-free and clean as possible.
•Another important topic was “why” these injuries occur in the first place. Obvious answers include repetitive use of the tendon. Typing, smart-phone use, gardening tools are easy culprits. Other causes can be much more involved and complicated though. For example, achilles tendinopathy can often be traced back to poor mechanics of the foot and ankle. Fallen arches of the foot can lead to excessive stress on the knee and hip joints. As a result, hip and leg muscles get overworked and stressed causing fascial tightness down the back of the leg, culminating in a tightness and eventual strain/tear of the achilles. So, in order to treat these injuries we need to think bigger than just Graston Technique and Laser and Exercise for the achilles. We need to consider an orthotic for the foot and further muscle and joint care for the hip.
•A great tip for treating these tendon injuries included the idea of “eccentric-loading” of the tendon during treatment and exercise. And, most importantly, we want to avoid “concentric-loading” of the tendon. So, an example includes the toe-raises we do to strengthen the achilles. At the beginning of rehab, we want to avoid the toe raise portion. Instead, we only want to focus on the lengthening portion as the heel drops down and below the level of the stair you’re doing the exercise on. The eccentric contraction improves the tissue strength and avoids the painful concentric contraction (the actual toe raise). This concept is applied to the treatment phase with Graston instruments as well.
I learned a lot more … will share in future posts. Today’s take home message: If you have tennis elbow, golfer’s elbow, or achilles tendonopathy, please come in to see me ASAP.