Tendon Healing

Tendon Healing

Educating yourself on the process of dealing with tendinopathies is a part of becoming a great calisthenics/rings athlete. Shoulders, elbows, and wrists are the hardest working joints in our practice, hence their relatively high risk of going through overuse injuries. Tendon injuries will occur, it is simply a matter of when, not if, even when all training and recovering aspects seem to sit perfectly in place. Whether and how you deal with them will dictate how much of your potential would be fulfilled.

Tendinitis and tendinosis are describing a state where an inflammatory response aggravates a joint, caused by damage in a tendon tissue nearby.

The amount of total quality tendon tissue is in the center of muscle-tendon performance. Healing the injury means you will rebuild and rearrange the tissues in a 'functional' manner, even exceeding previous amount of total quality tissue, surpassing previous athletic performance potential.

Treat the regimented routine as if it is training, because, as a matter of fact, it is. You will receive a lot of input from poking around the area, moving around space and going through the different stages. The experience will give you the confidence in preventing and treating further injuries.

The length of the rehab process will be determined by 1. The severity of the injury 2. The recency of the injury. It might take anywhere from 5-50 days.

You now have two frontiers:

1. Continuing to perform all exercises which certainly do not aggravate the injury in a traditional fashion.
2. Treating the injury in the following process:

Diagnosis

Throughout the rehab process, you will use the exact exercise(s) which targets the damaged tissues. If you know the exact exercise that caused the injury, use it precisely as that would be the most accurate. If you are not sure which exercise(s) caused the injury, try moving your arm around, with or without added resistance, in basic weight training patterns to find out where and when do you feel it. Pinpoint the exact exercise(s).

Pain

Acknowledging pain and communicating with it a part of having a good relationship with your body. Not all pain is categorized as "bad pain". Pain is, in general, a signal sent by the brain to 'Be Aware' of a possible (perceived) problem.

Performance and function are the key indicators of positive outcomes from the rehabilitation process, not necessarily the reduction of pain. Pain can also subside by indefinite rest, as inflammatory symptoms (redness, swelling, pain, reduction in range of motion, heat, etc.) would eventually drop, but the quality of the damaged tissues did not improve since they were not worked. Then, once you will load those tissues again, they will break under stress and be reinjured.

Going through pain is a part of the rehab process, otherwise we are not really targeting the damaged tissue. However, not all pain is the same. The exact type of pain you will feel is a crucial component to understand. When performing the exercise(s) in any stage of the rehab, the pain should be:

1. Sharp, knife-like type of pain.
2. Only be a 1-3, In a subjective scale of pain from 1 to 10.
3. "Ouch... Gone" type of pain. Meaning, it will not be prolonged into the rest interval or the following days.

Stage 1:

• Choose the exact 1 or 2 exercises that target the damaged tissue.
• Use light dumbbells, resistance-band, bodyweight or whatever allows all other guidelines to perform the exercise.
• Perform 40-70 repetitions per set, or simply 2-4 minutes of time-under-tension.
• DO NOT go to failure.
• Use the pain reference above.
• Perform 1-2 sets.
• Repeat the routine 3-5 times throughout each day, ideally separated by 2+ hours.

Keep doing stage 1 until pain significantly decreases while all other variables remain constant. Anywhere from 1-12 days.

Stage 2: Eccentric Loading Phase

• Choose the exact 1 or 2 exercises that target the damaged tissue.
• Use light dumbbells, resistance-band, bodyweight or whatever allows all other guidelines, to perform the exercise
• Perform 6-8 eccentric-only/eccentric-focused repetitions per set.
• The eccentric phase of each repetition would last 8 seconds.
• Perform, preferably, eccentric-only exercises. Assist yourself with the free arm on the concentric portion of the exercise if needed. Do not perform the concentric phase unassisted with the same intensity.
• DO NOT go to failure at any set.
• Use the pain reference above.
• Perform 1-2 sets.
• Repeat the routine 3-5 times throughout each day, ideally separated by 2+ hours.

Keep doing stage 2 until pain significantly decreases while all other variables remain constant. Anywhere from 1-12 days.

Stage 3: Concentric Loading Phase

• Choose the exact 1 or 2 exercises that target the damaged tissue.
• Use light dumbbells, resistance-band, bodyweight or whatever allows all other guidelines, to perform the exercise.
• Perform 10-15 full repetitions per set.
• Each repetition would be slow and controlled (tempo 2121), no acceleration.
• DO NOT go to failure at any set.
• Use the pain reference.
• Perform 1-2 sets.
• Repeat the routine 3-5 times throughout each day, ideally separated by 2+ hours.

Keep doing stage 3 until pain significantly decreases while all other variables remain constant. Anywhere from 1-12 days.

Stage 4: Conservative Strength Training

• Choose the exact 1 or 2 exercises that target the damaged tissue.
• Use light dumbbells, resistance-band, bodyweight or whatever allows all other guidelines, to perform the exercise.
• Perform 8-15 full repetitions per set.
• Each repetition would include an accelerative component (tempo 30X1) but remain controlled with great technique.
• DO NOT go to failure at any set.
• Use the pain reference.
• Perform 3 sets.
• Repeat the routine 3 times throughout each day, ideally separated by 2+ hours.

At this stage there should be no pain. Rehab has not been completed since we have not yet worked the elastic component of the tendons, which is one of its' most crucial performance qualities. Therefore, we work this quality under controlled environment.

This stage would take anywhere from 1-12 days. You are now, hopefully, fully healed.

That's it!

From this point on, you are free to pursue your strength training goals. Give yourself a few sessions with submaximal weight/variation until you catch up with previous performances, before training max-effort again.