Greg Lehman, a Toronto-based physiotherapist and strength coach known for his straightforward approach to rehabilitation, discusses the intricate world of tendons. He emphasizes the significance of individualized treatment plans, challenging traditional rigid approaches. The conversation delves into the complexities of tendinopathy, the critical role of tendon stiffness, and the impact of metabolic health on recovery. Lehman also explores innovative loading protocols and the balance between managing pain and maintaining athletic performance.
Simplifying the terminology around knee pain can enhance communication and streamline treatment approaches, regardless of specific diagnoses.
Tendon rehabilitation should prioritize gradual increases in activity rather than solely focusing on stiffness, as various methods can be effective.
Patient-centered care that aligns rehabilitation with individual performance goals is essential for athletes, ensuring both pain relief and functional recovery.
Deep dives
Simplifying Knee Pain Terminology
The discussion emphasizes the importance of simplifying the terminology related to knee pain, particularly conditions such as patellar tendinopathy and patellofemoral pain. The speaker suggests that instead of getting caught up in specific diagnoses, it may be more effective to refer to these as 'kneecap pain', as the treatment approaches tend to remain similar regardless of the diagnosis. This perspective challenges the conventional focus on identifying specific conditions and highlights that, in many cases, the treatment protocol does not significantly vary based on whether the injury is termed tendinopathy or another ailment. Ultimately, what matters more is understanding the individual and their sport to guide rehabilitation.
The Role of Tendon Stiffness in Rehabilitation
The conversation reveals that while tendon stiffness is often a focal point in rehabilitation, it might not be as crucial as previously thought. The speaker points out that with some conditions, such as bone injuries, stiffness could indeed matter, as reducing load is necessary for healing. However, with tendinopathy, the emphasis should be on gradually building individuals up towards their activity rather than strictly increasing stiffness. It is proposed that numerous approaches can be utilized in rehab to adapt the tendon to the demands of their sport, potentially leading to effective recovery even without an explicit focus on increasing tendon stiffness.
Analyzing the Efficacy of Training Protocols
The podcast debates the effectiveness of various training protocols, particularly contrasting heavy load training with lower load routines like manual therapy and medium load exercises. Studies have shown that while heavy loading programs increase tendon stiffness, they do not necessarily outperform other protocols in terms of pain relief or recovery outcomes. Insights from recent research argue that lower load exercises, including manual therapy, can yield similar or even superior results regarding function and pain relief. This suggests that the focus should not solely be on heavy loading but rather on the overall impact of the chosen rehab strategy.
Understanding Functional Tendons and Pain Triggers
The episode delves into the complex relationship between tendon function and pain, suggesting that the underlying mechanisms of tendinopathy might involve localized metabolic issues rather than just structural damage. It is posited that local interventions, whether through various types of exercise or loading techniques, may influence the health of the tendon by modulating inflammatory responses. This view indicates that even activities typically deemed low-impact or ineffective, such as light stretching or low-load exercises, might still have beneficial effects on tendon health and pain management. Such insights encourage a more holistic approach to tendon rehab, acknowledging varying responses across different individuals.
Tailoring Rehab to Individual Needs
The discussion discusses the necessity of patient-centered care in rehabilitation, emphasizing that different individuals have different goals. For athletes, particularly those involved in sports requiring explosive movements, the rehab must align with their performance aspirations, not just focus on pain reduction. The speaker acknowledges the importance of heavy lifting in certain rehab contexts to restore strength and function for athletes aiming to return to high-performance activities. This reinforces the philosophy that effective rehabilitation should consider both pain management and the functional demands of the patient's sport.
00:00 Introduction to Greg Lehman's Approach 03:06 Understanding Tendinopathy and Its Implications 05:59 The Role of Tendon Stiffness in Rehabilitation 09:06 The Complexity of Tendon Rehabilitation 12:01 The Importance of Individualized Treatment Plans 15:03 Exploring the Connection Between Metabolic Health and Tendon Pain 17:59 The Debate on Stretching and Tendon Health 21:04 Compression and Its Effects on Tendons 24:06 Managing Activity Levels During Rehabilitation 26:54 Evaluating Loading Protocols for Tendon Recovery 30:08 Muscle-Tendon Imbalance and Injury Risk 33:10 Research Insights on Tendon Adaptation 36:34 Understanding Tendon Strain Dynamics 39:04 Exploring Tendon Rehabilitation Protocols 42:54 The Role of Muscle in Tendon Health 46:24 Isometrics and Their Evolving Role in Rehab 56:36 Patient-Centered Care in Tendon Rehabilitation
Takeaways
The diagnosis often does not dictate treatment in rehab.
Tendon stiffness is a key factor in rehabilitation.
Individualized treatment plans are crucial for effective rehab.
Metabolic health can significantly impact tendon pain.
Stretching may still have a role in tendon health.
Compression effects on tendons are complex and not fully understood.
Maintaining activity levels can be beneficial during rehab.
Loading protocols should be tailored to the individual.
Muscle-tendon imbalances can increase injury risk.
Research continues to evolve our understanding of tendon adaptation. Tendon strain is influenced by joint angle and muscle contraction.
Isometric holds may not be the only effective method for tendon rehabilitation.
Patient-centered care is crucial in designing rehabilitation programs.
Performance goals should be integrated into rehabilitation strategies.
Muscle strength plays a significant role in tendon health and recovery.
The body can adapt to protect injured areas, complicating rehabilitation.
Isometrics can provide analgesic effects, but results vary among individuals.
Conscious isolation of muscle groups may be necessary for effective rehab.
Tendons respond to load, regardless of the type of contraction used.
Understanding individual patient goals is essential for effective treatment.
