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Whats up everyone,
I got this fantastic question from a reader that I wanted to answer. I’ve been wanting to dive deeper into the practical science and strategies of tendons and ligaments and their rehab, and this inquiry was perfect to do so
I have a shoulder pain from a tendonitis since 5 years.
My physiotherapist made me do everything that you qualifie as wrong here, so I understand now why it has never healed. I train normally, I just avoid bench press and shoulder press and use alternative exercises. I’m fine working out with the pain but I also practice MMA and it is a problem when it comes to do high intensity sparrings or trainings.
Here is my question : is my tendon still in rehab after 5 years ?
if so, do I replace my training by a rehab program ?
Or is it too late, and I keep training normally ?
Thank you for your answer, I’m glad to read finally GOOD advices on rehab, I feel like every doctor/physiotherapist I know is blocked in the ice/rest era.
Alright, I love this question. I can cover everything I wanted to talk about.
To preface, the treatment suggestions I give here are based off my own research the past weeks and application, as well as consulting with colleagues. This is not a 100% “guaranteed” to work suggestion, although I am confident it WOULD work if properly executed. That aside
If you didn’t read the past email, you can read it here
To start with,
WHY did the physiotherapists conventional strategies NOT work? This is not an uncommon situation after all: many many people go to physical therapy and find its effectivity to be low
Physical therapy priotizies PAIN over function. The goal is the get to the person to the most basic level of function, and mitigate the provocation of pain .
This is a good start point, but its not enough. Physical therapy does NOT generally focus on actual performance function
This results in the situation where the injured joint/muscle “works”, but never as well as it did before.
Is his Tendon still in rehab after 5 years though, YES, YES IT IS
Read this very carefully
When you damage a tendon, visually imagine as a very thick bundle of fibers running up and down vertically
Tendonitis happens when a section of those fibers tear and became frayed
BUT, your body will always try to heal. However, the healing process tends to be imperfect. Rather than lay down new fiber longitudinally (up and down), the body will “fill in” the damaged areas latitudinally
This is not just a visual metaphor, it is in fact what happens.
Imaging of damaged tendons and dissections of them will show decayed areas of the tendon the where the fibers did not align themselves properly.
Scar tissue that builds up is this defective collagen remodeling. This scar tissue rarely works as well as the original tendon though.
A damaged tendon has increased collagen turnover and is in a state of CONSTANT Inflammation and healing.
Even if its been years since the injury, its STILL trying to heal
This is why it HURTS. Its trying to repair itself, but CANT do it properly
WHY does the body not heal Properly though?
Because in the vast majority of rehab situations, the proper inputs are never applied.
FORCE IS THE LANGUAGE OF CELLS
The reason why Isometrics are so powerful is that the stress the connective tissue to remodel itself in the correct ALIGNMENT.
Its a stressor and signal to HEAL “this way”, not the defective way that comes with excess rest and inactivity and lack of movement.
How do we apply force properly?
Force is applied properly when the joint is trained to stabilize and move through anatomically functional ranges of motion
Rehab tends to fail because it
A) Does not address the joint functional as a whole
B) Does not apply appropriate levels of stress/force to rehab it back to athletic performance standards
What do we do for the Shoulder then?
This is what you would do
A) You would isometric deltoid raises for the front delt, medial delt, and posterior delt
The front and medial delt isometrics would be done standing. You would hold a DB at arms lengrh, and aim for 3 minutes TOTAL of isometric hold in each position, divided into subsets of 30-90 seconds
The Posterior Delt Isometric would be done from a “bent over” position
B) If you can do deltoid raises without pain, DO THEM
These would be done for 2-3 sets, for 10-20 reps, with DBs
C) For Shoulder pressing and chest pressing, you would utilize isometrics as well
This would likely require machiness to do these properly
You’d need to set the weight stack down to the heaviest setting, so the lever arms dont move
You would position your arm and shoulder to 90 degree angle at the bend of the elbow, and then you’d PRESS (isometrically)
You’d do an isometric shoulder press, for 4 sets of 30 seconds
Then you’d do an isometric chest press, for 4 sets of 30 seconds
IF an Isometric is painful, cant be done
You would do a STATIC Hold. You’d take an appropriately heavy weight, and hold it in place. You’d do this for 4 sets of 30 seconds
Whats the difference between a static vs Isometric?
A static hold you are simply holding onto the weight and resisting it pushing you donw.
An isometric you are actively producing as much force as possible against the weight (this is why its critcal that its a weight TOO heavy to move. You need an immovable object that allows maximum force production)
You Would do the Above Routine 3-4 times a week.
Assuming that progress begins to happens and pain decreases
D) Overtime, you’d want to move into doing normal compound movements with HEAVY weights
While I’d advise AGAINST barbell pressing, I would advise using DBs, machines, hammer strength machines, and the smith machines.
You’d want to perform your sets in the 6-10 rep range. The goal would be progressive overload, done slowly over a long period of time.
For the shoulder specifically, I’d suggest a machine overhead press, and 1-arm DB press
For Chest, similarly, a DB press, and a machine chest press of some kind
E) In addition to all the above, supplement with Hydrolyzed collagen.
I had a number of people ask if there is a specific supplement brand I recommend.
If you dont want to order from them though, there are a number of solid brands on amazon.
The recommended dosage for healing is 10 grams a day. I’d suggest consuming it PRE training so its already in your system to expedite the recovery process.
That is everything I think…
Let me know how it goes if you apply this. For anyone that has existing shoulder issues, this is worth trying
If you have questions on the above, or want a customized protocol for yourself using the above principles
Love you all,