I can't tell you how comforting this is. I think so many of us with any sort of tendinopathy feel utterly lost at what to do and feel like we are walking through the dark trying to find our way out of it. I stupidly decided to rapidly increase my squat load in a few week span about a year ago, and here I still am struggling with knee issues daily.
Hey mate. I'm recovering from a longhead bicep issue for the 2nd time. First time I reduced chest load and had huge success recovering. My training didn't change much, just a few months off biceps. I eventually went balls to the wall with chest again, and bam. This time I rested it thinking I needed more rest. Worst thing I ever did. 6-8 months lost due to me resting my tendon. I'm having a hard time getting a good footing on it, since it's just got weaker in the down time. I will say this though... as soon as I started loading it again carefully, it felt great. If I had of known loading was so important and resorted to my first protocol, I wouldn't be where I am today. I don't know what your exact issue is, but one guy on TH-cam Natural Galliant Bodybuilding did a video on exercises that cause tendon pain. He said you want to do the same exercise, but at a lighter weight. The logic is the weight is too much, but you want to keep the movement so you know it's targeting the tendon. From my experience, loading has always been the answer. It's finding the right load that is the problem. A good rule of thumb is any weight that doesn't cause pain, even if that means you are dropping it in half. Maybe rest a few days to allow inflammation to settle, if there is any. I try to load my bicep twice a week through DB floor presses and bicep curls; both incorporate shoulder flexion. I hope this helps. Just don't give up mate. Tendons respond very well to load... the right amount of load. Trial and error. Write down exactly what load you are using and keep going til you have no pain under load.
@@TaxEvasi0n I have had a nagging longhead bicep issue playing pickleball - it was an overextension. The injury kept going and coming and i will definitely start bench pressing after watching this video. I come from powerlifting so I know how to progress loads. Now, my lateral knee pain is bothering me and I may do the same with squats or single leg lunges.
@@Xand3r7 You need to train it. Resting tendons for months hoping it will get better is what put me behind - it never stopped aching. Only until I started training did it immediately feel better.
I absolutely adore you, great great information!! Thank you so much for for making it available to the entire health sciences community and people with questions about their injuries. I admire you so much and hope I can impact the rehabilitation field as much as you have done! :)
I think tendon injuries are much more complex than how clinicians see it. Here it is suggested that tendons should be loaded and never rested. I think it should be different treatment plans for different tendons. I had posterior tibial tendon pain for 5 years and only thing worked for me was resting in complete non-weight bearing for 30 days and have 20 sessions of hyperbaric oxygen therapy. 3 months after this treatment I could start walking again. When I had this treatment suggested some doctors were extremely against it. But the doctor in hyperbaric oxygen therapy told me I might have partial and micro tears in my tendon, since I was always stepping on it, it wasn’t properly healing. This was the only time I could feel a bit relief. For 5 years I tried ozone shots, ESWT, endless sessions of physical therapy, massage, custom made orthotics, New balance 990 shoes etc. they also gave some relief but didn’t fix the issue. Every doctor has a different view on this.. Some thinks zero shoes would help while others offers higher stiff shoes with lots of cushioning. Some says put ice while others suggest that ice is delaying the healing process. Very difficult to get a solid answer. I wish everyone a speedy recovery and finding the way works best for them.
You had that for 5 years then thats on you. You didn’t listen to your body due to your ego. You probably didn’t listen to your therapist hence you had that for 5 years. If you did the right rehab then it wouldn’t get to 5 years. A bit of self reflection goes a long way.
@@jacklauren9359 Sure I was very young and didn’t know how to listen to my body. I only followed what healthcare professionals told me. However I can clearly say the clinicians have very opposite ideas about tendon healing. The first time I visited the doctor; it was the very next day of injury, he told me I was perfectly fine and just gave me pain killers & ibuprofen cream. I continued to work as a tour guide which requires a lot of walking. He didn’t tell me to rest it or take care of it or put me in a walking booth. I think that was the biggest mistake. After a week of pain I went back and they did mri and xrays, with more blood&bone tests. Then they started physical therapy and I was told that it wasn’t anything serious. I think I wasn’t informed enough and it was misdiagnosed. Moreover most of the hospitals have 1,5 tesla MRI, not 3 tesla. 1,5 Tesla MRI doesn’t show the micro tears on tendon or lesions which makes the doctor think you are perfectly healthy. They can’t see the lesions or tears, they only see broken bones or severe injuries. So I can say in 2024, the body monitoring systems aren’t very well developed. When patients aren’t informed or diagnosed correctly, it is not left to our egos to decide. We follow what doctors tell us. We ask a healthcare professional who studied human body for years. I just write this in case if anyone is suffering from foot pain and doesn’t know what to do, maybe it can give them some ideas. I am writing what worked for me and how I was very confused with opposite ideas. Of course each case is different and it needs to be handled individually. Let's be kinder to patients who are already suffering instead of judging the lives we have no idea about. Ego, self reflection or blaming the patient never cured a sickness before. 🙂 Stay blessed my friend 🌿🌿🌿
@@mahsheenman I actually didn’t do any exercises because it was worsening my pain. Especially stretching was making it very bad. Since I had a micro tear which cannot be monitored on MRI, I really really rested my feet. I did complete non weight bearing for a month. Then I started to walk slowly. If I needed I used crutches and wheelchair. I really let it heal by itself, never forced it.They say I needed to load the tendon but for my case it was very painful and it was worsening. However my case might not be same as yours. I couldn’t perform single leg raises which shows that my posterior tibial tendon wasn’t functioning properly. Now there are more resources out there. Especially on instagram you can see different podiatrists talking about different cases, showing how to make self-tests. Maybe you can get some ideas from there too. Wishing you a speedy recovery. 🌿
I rested a tendon for 6-8 months. Worst thing I had ever done. As soon as I lightly loaded it, approx 50% of the original weight, it felt better by end of week. Tendons respond well to healing under loading.
@@abdoukarimsanneh Yes, absolutely. Best thing I ever did was train it again carefully. I moved to a 'time under tension', 'slow and controlled' style for 3 sets of 15 reps. It was heavy weight but it wasn't max weight, maybe 25% less than my max. I used to fear triggering it or overdoing it. I no longer fear if I "piss it off" anymore, because I know how to effectively load it. It used to get me really depressed. Of course it depends on the cause of the issue, like I had poor shoulder mechanics so I had to work on that also. But now, I am pain free. I had many months of aches and pains, thinking I just needed to rest it, and it never healed that way. Loading it appropriately was the best thing ever and I kick myself for wasting SO MUCH time, I lost a lot of muscle mass during that time. 👍🏼💪🏼
@@TaxEvasi0n thank u so much,I am suffering from pht I hv been loading for a month now it's improving but something pains like a cut . below the hip down to the hamstring.i think that is sciatica
@@abdoukarimsanneh I don't know what PHT is, but if you have sciatica, that may be a separate issue all together. Loading tendons is good for pathology of the tendons. You might have a nerve compression problem.
Dr. Michael Fabrick used this exact approach to help me with some severe golfers and tennis elbow. He used this framework with dry needling. He is in Orlando, FL and works at Pursuit Physical Therapy.
You mentioned that a tendon with pathology will always have that pathological part but may still have as much or more of a non-pathological part as a normal tendon. Wouldn't that imply that a pathological tendon has grown bigger (in compensation)? If so, what about a shoulder problem due to an impinged supraspinatus tendon, where the problem arose to begin with because the tendon has to exist in a very small sub-acrominal space, where, if everything in the shoulder doesn't move correctly, the tendon gets impinged. And now, that pathological tendon has grown larger, even while it still has to occupy that same small space. Wouldn't that tendon now be even more subject to impingement because, basically, the tendon has grown too large for the space and will forever be that way, since the pathological part never goes away? And so, wouldn't the problem be self-perpetuating for the rest of your life?
T here is an orthopedic surgeon in the United States who has come up with a simple way to deal with many shoulder problems. I have suffered two frozen shoulders over the past 15 years and both times they wanted to do surgery. I used his technique both times and it worked beautifully. his book is available on Amazon. The title is "Shoulder Pain The Solution And Prevention and it's written by Dr. John Hirsh. Can't say enough good about this doctor and his wonderful book. Give it a read and I think you will be starting down a road leading to recovery!
Also what prevents the bad tissue from keeping growing?? If we are gonna load the tendon to regain strength in the healthy tissue, what prevents further damage to the bad one if according to Her bad tissue never heals?
@@garymartin23 check out the TH-cam channrl smashwerx. Hes a doctor who's also a competitive athlete. You'll get a lot more useful info out of him than most doctors. And most surgeries are unnecessary.
This was awesome! i will try to apply this knowledge to heal my chronic golfers elbows..if i am ever successful i will pass this knowledge further to help everyone. Again thank you!
Let us know how it turns out, heavy loading sounds detrimental to healing the tendons but I am curious to know if it helped. I have tears in 4 of my tendons for 3 months so far
@@kirayamato1722 hi, i had to have right elbow surgery..that 100% helped..chiropracic massages and antiinflammatory medicines did not help to cure that chronic golfers elbow..left elbow was not so severe and that left one i experience returning pain after some workouts etc..also i had to change my job..from being a welder to much less physically demanding job.
4 years with pain, and only with medication, I was even misdiagnosed that my triceps hurt because of cervical hernia, even when the hernia was very light, the doctor apparently didn’t have the knowledge to diagnosis it with laboral overuse lesion , even when the doctor was described the kind of repetitive long-hour factory work I was doing ( hopefully well-translated , because the translator was the secretary of the hiring company I was working for, and for some reason all the women who work in the same labor got diagnosis with cervical or dorsal hernia by the same doctor , and still after quitting the job, years after they can’t function normally... I asked many times a MRI but was denied, “ not necessary “-he said , and to prove it , lay my head back more strongly and of course the light hernia radiated to my arms until my fingers.... hope he gets rich ...the laboral insurance doesn’t cover lesions related to the spine, I was told later by this secretary... so.... welcome to Japan! First world country!... everywhere, there are injustice... people taking advantage of the need of other people , eg. migrants who don’t know the legal system or the language ). Just when I went by myself to another doctor and tried in my poor Japanese to explain, he diagnosed me with overuse lesion, but the treatment is only medication).
thank you for this valuable presentation , unfortunately I was operated for Achilles tendon rapture last February 2020 but during April i lost my physiotherapy sessions because of Corona Virus and curfew ,staying at home during April . I feel I have lack of adaptation to the muscle and less healing process , but this didn't stop me from trying to move and do minor exercise I am still using supports to walk specially outside home , what is your Advise ? best regards . Ahmad , Saudi Arabia .
I'm not an expert, but I think that you shouldn't stop exercising. Try to recreate program that you had on physical therapy. I suffer frozen shoulder combined with partial rupture of biceps tendon and I also stopped with sessions because of Corona, but I exercise at home each day doing stuff learned on sessions and from Internet.
My god I'd kill to get a program like this (at 18:22) for ulnar flexor tendon (in the forearm). My PTs always send me home either with stretches or with eccentrics. Yes I see from the video that I should start with isometrics, but I have no idea about the correct load and no idea when I am ready to move from stage 1 to stage 2 of this program. Finally I have no idea whether a program made for achilles tendinopathy will always work for forearm tendons.....it's just so damn frustrating.
@@kurton1100 Nope. You gotta make up your own. For flexor I do farmers carries. For tricep I do tricep kickback and pushdown. Slow, controlled eccentrics. Biceps I'd imagine hammer curls and bicep curls. Extensor tendons I'd look into tyler twists. Wrist curls/reverse wrist curls just end up hurting my wrist so I stopped them. Farmers carry gives me all the forearm I need.
@@kurton1100 use isometrics as a strengthening method. 5 to 6 seconds of tension against immovable object. 2-3 of them are with maximum force. Do it every day. Don't do any more than 6 seconds per day. Trust me. It works
I'm watching this because I'm only 25 and I have gluteus medius insertional tendinopathy with a 5 mm partial tear at the undersurface of the tendon and associated iliopsoas bursitis in the right hip (as seen on MRI imaging). The left hip report mentions evidence of minute joint effusion at the femoral head, possibly "within normal ranges". Until the MRI, doctors dismissed me. X-Ray and Ultrasound were inconclusive. I've had pain for over 3 years and I've been doing physical therapy for 2 years now. It seems to only get worse but if I stop the exercises the severity peaks and the pain becomes unbearable. It hurts to walk, to sit, to lie on the right side, I can't run and in fact the 5 mm tear likely came from trying to run as I thought doing that would strengthen my legs. The pain recently crossed from occasional but frequent, to constant. There's no stability in my right hip and it even makes my right knee buckle inward with pain (Trendelenburg gait - at only 25!!). I recently purchased a book called Lower-limb Tendinopathy: (Achilles, Patellar, Hamstring and Gluteal) by Daniel Lawrence and I'm eagerly waiting for it to arrive, to see what I can be doing differently.
I'm really sorry to hear this I hope you are doing a little better now. Have the doctors mentioned anything about the tendon tear healing on its own and if cortisol shots would help with the extreme pain? You are too young to be having these issues. I'm 27 and have pain so extreme in my forearm/wrist that it keeps me up at night. Apparently, tendon related issues are more common than anyone realizes...
@@hyperashitive3217 Hi there, yes, this tendon pain also causes sleeping problems as there is no comfortable way to stand, sit, or lay (it's the hip). I actually did see an orthopedic surgeon about it, who said I need to just continue doing exercise therapy, more of it, and maybe with specialists. Corticosteroid injections have the potential to actually weaken the tissues around the damaged tendons, and reduce their capacity to bear load, though they may provide short term pain relief. I was also advised to do what I can to reduce the pain so that I can do the exercises (like taking anti-inflammatory medication). Another thing that was mentioned is that a lot of the pain is actually nervous system sensitization, and doesn't necessarily mean harm has occurred. But it does mean that you can mend the tendon to a healthy state and still have pain.
Hey man.i have same problem like u but in the past 1/5 years ago I think its the muscle pain.use anti inflammatory it can help u and search about peptide bpc 157.i hope u get well soon🙏
I’m so sorry to hear that! I am in a similar situation, also the right hip. I had tendinopathy and somehow I got a tear even though I was loading at PT so I don’t know if I can agree with what she has said about loading!! I’m going to look into that book that you mentioned. Get well soon.
Hey, Great video! I was wondering can we tear our collagen or not? You said collagen tearing is impossible but then go onto say it exists but a consequence of another process ? Was wondering if you could clarify this for me please. Thank you.
Im not Jill Cook ;)..... But as far as i understand from the video. A healthy tendon is most unlikly to tear (impossible). But a pathological tendon (consequence of other processes) can cause the tendon to tear :).
@@austinsteiner5822is the achilles tendonitis the same as quadtricep tendonitis? Like do i or we follow the same rehab program? And 5 months after how you feel now? Sorry i asked to much here but would appreciate every answar!!
Excellent speech.My experience show that you are absolutely correct.Gradually move and load the tendon is extremely helpful.However when there is pain.It makes things much more difficult.Do we have to take painkillers to reduce the pain before we embark on our exercise.
Very good question. Yes I believe also in movement helps greatly. Gradually, step by step, you can built up your refreshed oxygen network, which on its turn rebuilts other internal connections. ♥️
o very interesting and informative. I am a very active, my husband is partially sighted, our eldest daughter is Spina Bifida and our youngest daughter has autism. I am thrilled to hear that rest is not recommended to a great degree - how can I rest? I am a light sleeper, I never nap and am always using all my spare time sewing and doing crafts. So.. I can keep my lifestyle (no option really) in the knowledge that movement and loading is actually adding to my rehabilitation. I always maintain that mobility is the source of a long life!! thanks
Compressive forces occur in tendons where the tendons pass bony protuberances. During specific movements, the tendons become compressed against these bony protuberances.
I want to say 'knees-over-toes' style of exercises would be compressive loads. This is why they are stage 3, yet some people go for these very early in their programs.
@@johngiovanni6045 what does that mean? I currently have a distal bicep tendinoopathy and have been doing isometric bicep curls for 45 seconds, working my way up weight every 2 weeks or so (as well as bicep and upper forearm self massaging). In my case what would it mean to add compressive loads/ forces? Does that mean to get a band and wrap it tightly around my bicep tendon to increase blood flow? Or is it a specific movement pattern that the term 'compressive forces' refers to?
I wonder whether my amplified AuDHD is causally related to inflammation and recent post-exercise tendoninopathy .... (the added wrinkles are that I had a complex medial meniscus tear on the same (right) leg which took many years to get basic function post-surgery and that a decade of undiagnosed hypercalcaemia led to some extra weight (≈20 kg more than my usual running weight 25 years ago).
Unfortunately this isn't supported by the experience of patients. Many people with tendonitis eventually develop partial or complete tears in the tendon, going into a downward spiral of tear, regrowth, and re-tear. I wonder if this team has been selectively choosing their patients.
is it possible that high lactic acid caused by high intensity and high volume training will support cell healing. It's well known that typical bodybuilding training higher reps to failure help with joint pain. maybe it also help the tendon.
walking is very aggrevating. When I started paying attention to my phone's pedometer, regonized the pattern that at about 4,000 steps, it triggered discomfort. Instead, use an indoor bike, not just lying on the couch. Sit on the floor, change positions, etc. Be mobile, just not constantly walking.
Outside of compression is meaning no compression on the tendon. So in a squat, when you’re going into deep knee flexion at the bottom of the squat, the quadricep tendon is in compression.
). Os exercícios de fortalecimento excêntricos do quadríceps são os mais usados nos processo de reabilitação, apesar dos resultados do trabalho de Cannell et al, que compararam exercícios excêntricos com concêntricos e em ambos os tratamentos encontraram resultados favoráveis em relação à dor e ao retorno ao esporte; houve ligeira tendência de o retorno ao esporte ser mais comum nos pacientes que foram submetidos aos exercícios excêntricos(60). O fortalecimento excêntrico do quadríceps parece aumentar a atividade metabólica, incrementando a síntese de colágeno tipo I
This information is in this text (in Portuguese) www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-36162008000800001 I don't speak English nor Spanish... If you don't understand Portugues, use the Google Translate to help you = )
Hi Everyone, I'm not sure to understand, is eventually the damaged part of the tendon replaced by healthy tissue? Or will the damaged tissue always be there...?
@@wvyabhi But did I understand correcrly that your are most likely to have, along with the damaged tissue, even more healthy tissue than a normal tendon?
@@wvyabhi Oh ok, I get it, thanks. Also, I didn't quite understand what she meant by compressive loading. I personally have a distal bicep tendinopathy (not sure what exaclty but it's not a rupture and there's pain right at the elbow and surrounding areas including the upper part of the forearm). Would compressive loading mean doing the rehab im currently doing: bicep curl isometrics but with like a reistance band wrapped somewhat tightly around my bicep to 'compress' it and increase bloodflow? Or is compressive loading/ forces something else in my case?
@@guyw1thbeanie Oh I see. i'm not an expert at all so you should probably work with a physical therapist, but i don't think compressive loading refers to compressing the tendon literally with a resistance band. i think you would probably be making it worse since you're restricting / affecting the range of motion. it's good that you don't have a rupture, but i would take it slow and make sure to combine isometrics with high rep (but challenging) eccentrics. this is how i got rid of my tendonitis. it takes time, but there will be blood flow
How is it that the ends of the Achilles tendon are in compression when the foot is in dorsiflexion? It would seem like the whole tendon is being stretched out, not compressed. Also, are energy storage loads present when the tendon is in compression or when it is being stretched? For the Achilles tendon, would this correspond to the foot being in plantar flexion?
I guess when the heel is raised, the calve muscle is constricting, which could stretch the Achilles tendon (aka energy storage load I think), but I don't completely understand how when the heel is lowered, the Achilles is in compression. Like, maybe the calve muscle is stretched out and pushes the Achilles tendon into compression? I would think both the calve muscle and Achilles tendon would be stretched out. I guess maybe not.. maybe the muscle and tendon are always in opposite states to one another.
I have tendinitis in my knee (LCL) from biking alot and not matter what I do I cant cure it. Cold compress rest etc. When I walk alot or bike it hurts. It has gotten a bit better. do you know what I should do?
So if the tendon tore came from wear and tear and maybe heavy lifting, wouldn’t the same activity cause it not to heal? And maybe even make the tear worse?
With the right amount of load it will heal. The body will adapt but you must give it the right amount of stimulus to do so. Too much stimulus and it will get worse.
And the worse is when what caused the lesion was work, but still you have to work with your arms and hands( in my case) , or whatever they work with. Even when you try to , repetitively factory work doesn’t help.... I am writing this hoping people can be warned and take better decision if possible ( not always, it seems to us that we have too much choice, specially in economical crisis times). Sports? Unless your profession is sports, the rest of people shouldn’t abuse their bodies.
![BOWKYLION - วิงวอน (ex-change) [Official MV]](http://i.ytimg.com/vi/cLdnZWDaO-w/mqdefault.jpg)
Dr Cook, You are an inspiration for all physiotherapists!!
Thank you very much. 14 years earlier would have helped a lot, but better start now than never.
Same😢
L
I can't tell you how comforting this is. I think so many of us with any sort of tendinopathy feel utterly lost at what to do and feel like we are walking through the dark trying to find our way out of it. I stupidly decided to rapidly increase my squat load in a few week span about a year ago, and here I still am struggling with knee issues daily.
Lol loser
Hey mate. I'm recovering from a longhead bicep issue for the 2nd time. First time I reduced chest load and had huge success recovering. My training didn't change much, just a few months off biceps. I eventually went balls to the wall with chest again, and bam. This time I rested it thinking I needed more rest. Worst thing I ever did. 6-8 months lost due to me resting my tendon. I'm having a hard time getting a good footing on it, since it's just got weaker in the down time. I will say this though... as soon as I started loading it again carefully, it felt great. If I had of known loading was so important and resorted to my first protocol, I wouldn't be where I am today.
I don't know what your exact issue is, but one guy on TH-cam Natural Galliant Bodybuilding did a video on exercises that cause tendon pain. He said you want to do the same exercise, but at a lighter weight. The logic is the weight is too much, but you want to keep the movement so you know it's targeting the tendon.
From my experience, loading has always been the answer. It's finding the right load that is the problem. A good rule of thumb is any weight that doesn't cause pain, even if that means you are dropping it in half. Maybe rest a few days to allow inflammation to settle, if there is any. I try to load my bicep twice a week through DB floor presses and bicep curls; both incorporate shoulder flexion. I hope this helps. Just don't give up mate. Tendons respond very well to load... the right amount of load. Trial and error. Write down exactly what load you are using and keep going til you have no pain under load.
@@TaxEvasi0n i am resting with tendon bicep at the elbow for 1 year now and quit all my activities, please help
@@TaxEvasi0n I have had a nagging longhead bicep issue playing pickleball - it was an overextension. The injury kept going and coming and i will definitely start bench pressing after watching this video. I come from powerlifting so I know how to progress loads. Now, my lateral knee pain is bothering me and I may do the same with squats or single leg lunges.
@@Xand3r7 You need to train it. Resting tendons for months hoping it will get better is what put me behind - it never stopped aching. Only until I started training did it immediately feel better.
I absolutely adore you, great great information!! Thank you so much for for making it available to the entire health sciences community and people with questions about their injuries. I admire you so much and hope I can impact the rehabilitation field as much as you have done! :)
I think tendon injuries are much more complex than how clinicians see it. Here it is suggested that tendons should be loaded and never rested.
I think it should be different treatment plans for different tendons.
I had posterior tibial tendon pain for 5 years and only thing worked for me was resting in complete non-weight bearing for 30 days and have 20 sessions of hyperbaric oxygen therapy. 3 months after this treatment I could start walking again. When I had this treatment suggested some doctors were extremely against it. But the doctor in hyperbaric oxygen therapy told me I might have partial and micro tears in my tendon, since I was always stepping on it, it wasn’t properly healing.
This was the only time I could feel a bit relief.
For 5 years I tried ozone shots, ESWT, endless sessions of physical therapy, massage, custom made orthotics, New balance 990 shoes etc. they also gave some relief but didn’t fix the issue.
Every doctor has a different view on this.. Some thinks zero shoes would help while others offers higher stiff shoes with lots of cushioning.
Some says put ice while others suggest that ice is delaying the healing process.
Very difficult to get a solid answer. I wish everyone a speedy recovery and finding the way works best for them.
I have a similar issue. What kind of loading did you do at physical therapy? Did you try isometric loading (as the video suggested)?
You had that for 5 years then thats on you. You didn’t listen to your body due to your ego. You probably didn’t listen to your therapist hence you had that for 5 years. If you did the right rehab then it wouldn’t get to 5 years. A bit of self reflection goes a long way.
@@jacklauren9359 Sure I was very young and didn’t know how to listen to my body. I only followed what healthcare professionals told me.
However I can clearly say the clinicians have very opposite ideas about tendon healing. The first time I visited the doctor; it was the very next day of injury, he told me I was perfectly fine and just gave me pain killers & ibuprofen cream. I continued to work as a tour guide which requires a lot of walking. He didn’t tell me to rest it or take care of it or put me in a walking booth. I think that was the biggest mistake. After a week of pain I went back and they did mri and xrays, with more blood&bone tests. Then they started physical therapy and I was told that it wasn’t anything serious. I think I wasn’t informed enough and it was misdiagnosed.
Moreover most of the hospitals have 1,5 tesla MRI, not 3 tesla. 1,5 Tesla MRI doesn’t show the micro tears on tendon or lesions which makes the doctor think you are perfectly healthy. They can’t see the lesions or tears, they only see broken bones or severe injuries. So I can say in 2024, the body monitoring systems aren’t very well developed. When patients aren’t informed or diagnosed correctly, it is not left to our egos to decide. We follow what doctors tell us. We ask a healthcare professional who studied human body for years. I just write this in case if anyone is suffering from foot pain and doesn’t know what to do, maybe it can give them some ideas. I am writing what worked for me and how I was very confused with opposite ideas. Of course each case is different and it needs to be handled individually.
Let's be kinder to patients who are already suffering instead of judging the lives we have no idea about. Ego, self reflection or blaming the patient never cured a sickness before. 🙂 Stay blessed my friend 🌿🌿🌿
@@mahsheenman I actually didn’t do any exercises because it was worsening my pain. Especially stretching was making it very bad. Since I had a micro tear which cannot be monitored on MRI, I really really rested my feet. I did complete non weight bearing for a month. Then I started to walk slowly. If I needed I used crutches and wheelchair. I really let it heal by itself, never forced it.They say I needed to load the tendon but for my case it was very painful and it was worsening. However my case might not be same as yours. I couldn’t perform single leg raises which shows that my posterior tibial tendon wasn’t functioning properly. Now there are more resources out there. Especially on instagram you can see different podiatrists talking about different cases, showing how to make self-tests. Maybe you can get some ideas from there too. Wishing you a speedy recovery. 🌿
I rested a tendon for 6-8 months. Worst thing I had ever done. As soon as I lightly loaded it, approx 50% of the original weight, it felt better by end of week. Tendons respond well to healing under loading.
Is urs okay now by using these
@@abdoukarimsanneh Yes, absolutely. Best thing I ever did was train it again carefully. I moved to a 'time under tension', 'slow and controlled' style for 3 sets of 15 reps. It was heavy weight but it wasn't max weight, maybe 25% less than my max.
I used to fear triggering it or overdoing it. I no longer fear if I "piss it off" anymore, because I know how to effectively load it. It used to get me really depressed. Of course it depends on the cause of the issue, like I had poor shoulder mechanics so I had to work on that also. But now, I am pain free.
I had many months of aches and pains, thinking I just needed to rest it, and it never healed that way. Loading it appropriately was the best thing ever and I kick myself for wasting SO MUCH time, I lost a lot of muscle
mass during that time. 👍🏼💪🏼
@@TaxEvasi0n thank u so much,I am suffering from pht I hv been loading for a month now it's improving but something pains like a cut . below the hip down to the hamstring.i think that is sciatica
@@abdoukarimsanneh I don't know what PHT is, but if you have sciatica, that may be a separate issue all together. Loading tendons is good for pathology of the tendons. You might have a nerve compression problem.
@@TaxEvasi0n pht is proximal hamstring tendinopathy closer to the glutes I think it's the one compressing the nerve.so can I load even with sciatica?
Outstanding information ; This information is helping me on my tendinitis .
I wish youtube had become a thing in 1995 rather than 2005 then I wouldn't have made every preventable mistake in the book about this stupid injury
If it makes you feel any better the research probably wasn’t quite there yet either in 1995
Anyone knows, who is the Jill Cook of elbow tendinopathy? Would be great to hear such useful insights from an upper limb expert too.
Dr. Michael Fabrick used this exact approach to help me with some severe golfers and tennis elbow. He used this framework with dry needling. He is in Orlando, FL and works at Pursuit Physical Therapy.
Thanks for your info. At least we know now, what's going on, and how to manage the issue. ♥️
You mentioned that a tendon with pathology will always have that pathological part but may still have as much or more of a non-pathological part as a normal tendon. Wouldn't that imply that a pathological tendon has grown bigger (in compensation)? If so, what about a shoulder problem due to an impinged supraspinatus tendon, where the problem arose to begin with because the tendon has to exist in a very small sub-acrominal space, where, if everything in the shoulder doesn't move correctly, the tendon gets impinged. And now, that pathological tendon has grown larger, even while it still has to occupy that same small space. Wouldn't that tendon now be even more subject to impingement because, basically, the tendon has grown too large for the space and will forever be that way, since the pathological part never goes away? And so, wouldn't the problem be self-perpetuating for the rest of your life?
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T here is an orthopedic surgeon in the United States who has come up with a simple way to deal with many shoulder problems. I have suffered two frozen shoulders over the past 15 years and both times they wanted to do surgery. I used his technique both times and it worked beautifully. his book is available on Amazon. The title is "Shoulder Pain The Solution And Prevention and it's written by Dr. John Hirsh. Can't say enough good about this doctor and his wonderful book. Give it a read and I think you will be starting down a road leading to recovery!
there is no shoulder impingement
Also what prevents the bad tissue from keeping growing?? If we are gonna load the tendon to regain strength in the healthy tissue, what prevents further damage to the bad one if according to Her bad tissue never heals?
I need this woman to heal me
Barry Woods that’s put a right dampner or my injury
Barry Woods I suppose I’ll remain in pain then
Barry Woods I’m on the second year already tried everything
Barry Woods yes surgery is not an option for me .. can’t take the risk also would definitely lose elasticity
@@garymartin23 check out the TH-cam channrl smashwerx. Hes a doctor who's also a competitive athlete. You'll get a lot more useful info out of him than most doctors. And most surgeries are unnecessary.
Nice yet forceful presentation that hives hope.
Fantastic information here! Thanks Dr. Cook!
This was awesome! i will try to apply this knowledge to heal my chronic golfers elbows..if i am ever successful i will pass this knowledge further to help everyone. Again thank you!
u healed yet
Let us know how it turns out, heavy loading sounds detrimental to healing the tendons but I am curious to know if it helped. I have tears in 4 of my tendons for 3 months so far
Any updates? I have the same thing.
@@kirayamato1722 hi, i had to have right elbow surgery..that 100% helped..chiropracic massages and antiinflammatory medicines did not help to cure that chronic golfers elbow..left elbow was not so severe and that left one i experience returning pain after some workouts etc..also i had to change my job..from being a welder to much less physically demanding job.
Surgery seems initimidating. I heard there's a 50/50 chance of success or aggravating the injury.
4 years with pain, and only with medication, I was even misdiagnosed that my triceps hurt because of cervical hernia, even when the hernia was very light, the doctor apparently didn’t have the knowledge to diagnosis it with laboral overuse lesion , even when the doctor was described the kind of repetitive long-hour factory work I was doing ( hopefully well-translated , because the translator was the secretary of the hiring company I was working for, and for some reason all the women who work in the same labor got diagnosis with cervical or dorsal hernia by the same doctor , and still after quitting the job, years after they can’t function normally... I asked many times a MRI but was denied, “ not necessary “-he said , and to prove it , lay my head back more strongly and of course the light hernia radiated to my arms until my fingers.... hope he gets rich ...the laboral insurance doesn’t cover lesions related to the spine, I was told later by this secretary... so.... welcome to Japan! First world country!... everywhere, there are injustice... people taking advantage of the need of other people , eg. migrants who don’t know the legal system or the language ). Just when I went by myself to another doctor and tried in my poor Japanese to explain, he diagnosed me with overuse lesion, but the treatment is only medication).
an analogue of lifes setbacks, really.
thank you for this valuable presentation , unfortunately I was operated for Achilles tendon rapture last February 2020 but during April i lost my physiotherapy sessions because of Corona Virus and curfew ,staying at home during April . I feel I have lack of adaptation to the muscle and less healing process , but this didn't stop me from trying to move and do minor exercise I am still using supports to walk specially outside home , what is your Advise ?
best regards . Ahmad , Saudi Arabia .
I'm not an expert, but I think that you shouldn't stop exercising. Try to recreate program that you had on physical therapy. I suffer frozen shoulder combined with partial rupture of biceps tendon and I also stopped with sessions because of Corona, but I exercise at home each day doing stuff learned on sessions and from Internet.
My god I'd kill to get a program like this (at 18:22) for ulnar flexor tendon (in the forearm). My PTs always send me home either with stretches or with eccentrics.
Yes I see from the video that I should start with isometrics, but I have no idea about the correct load and no idea when I am ready to move from stage 1 to stage 2 of this program.
Finally I have no idea whether a program made for achilles tendinopathy will always work for forearm tendons.....it's just so damn frustrating.
Agreed brother!
Looking for the same. Forearm/elbow issues. Very few resources online about advanced programs like this for arms - its all legs.
@@Dartht33bagger Is there some loading program for the elbows? I have all 4 ( biceps , triceps, extensors and flexors calcification) tendons damaged.
@@kurton1100 Nope. You gotta make up your own. For flexor I do farmers carries. For tricep I do tricep kickback and pushdown. Slow, controlled eccentrics.
Biceps I'd imagine hammer curls and bicep curls. Extensor tendons I'd look into tyler twists. Wrist curls/reverse wrist curls just end up hurting my wrist so I stopped them. Farmers carry gives me all the forearm I need.
@@kurton1100 use isometrics as a strengthening method. 5 to 6 seconds of tension against immovable object. 2-3 of them are with maximum force. Do it every day. Don't do any more than 6 seconds per day. Trust me. It works
I'm watching this because I'm only 25 and I have gluteus medius insertional tendinopathy with a 5 mm partial tear at the undersurface of the tendon and associated iliopsoas bursitis in the right hip (as seen on MRI imaging). The left hip report mentions evidence of minute joint effusion at the femoral head, possibly "within normal ranges". Until the MRI, doctors dismissed me. X-Ray and Ultrasound were inconclusive.
I've had pain for over 3 years and I've been doing physical therapy for 2 years now. It seems to only get worse but if I stop the exercises the severity peaks and the pain becomes unbearable. It hurts to walk, to sit, to lie on the right side, I can't run and in fact the 5 mm tear likely came from trying to run as I thought doing that would strengthen my legs. The pain recently crossed from occasional but frequent, to constant. There's no stability in my right hip and it even makes my right knee buckle inward with pain (Trendelenburg gait - at only 25!!).
I recently purchased a book called Lower-limb Tendinopathy: (Achilles, Patellar, Hamstring and Gluteal) by Daniel Lawrence and I'm eagerly waiting for it to arrive, to see what I can be doing differently.
I'm really sorry to hear this I hope you are doing a little better now. Have the doctors mentioned anything about the tendon tear healing on its own and if cortisol shots would help with the extreme pain? You are too young to be having these issues. I'm 27 and have pain so extreme in my forearm/wrist that it keeps me up at night. Apparently, tendon related issues are more common than anyone realizes...
@@hyperashitive3217 Hi there, yes, this tendon pain also causes sleeping problems as there is no comfortable way to stand, sit, or lay (it's the hip). I actually did see an orthopedic surgeon about it, who said I need to just continue doing exercise therapy, more of it, and maybe with specialists. Corticosteroid injections have the potential to actually weaken the tissues around the damaged tendons, and reduce their capacity to bear load, though they may provide short term pain relief. I was also advised to do what I can to reduce the pain so that I can do the exercises (like taking anti-inflammatory medication). Another thing that was mentioned is that a lot of the pain is actually nervous system sensitization, and doesn't necessarily mean harm has occurred. But it does mean that you can mend the tendon to a healthy state and still have pain.
Hey man.i have same problem like u but in the past 1/5 years ago I think its the muscle pain.use anti inflammatory it can help u and search about peptide bpc 157.i hope u get well soon🙏
I’m so sorry to hear that! I am in a similar situation, also the right hip. I had tendinopathy and somehow I got a tear even though I was loading at PT so I don’t know if I can agree with what she has said about loading!! I’m going to look into that book that you mentioned. Get well soon.
Hey, Great video! I was wondering can we tear our collagen or not? You said collagen tearing is impossible but then go onto say it exists but a consequence of another process ? Was wondering if you could clarify this for me please. Thank you.
Im not Jill Cook ;)..... But as far as i understand from the video. A healthy tendon is most unlikly to tear (impossible). But a pathological tendon (consequence of other processes) can cause the tendon to tear :).
15:50 Eccentric exercise doesn't strenghten the muscle?! Really?? I am very surprised to hear that...
So,, has anyone EVER healed their tendonitis? Please give me HOPE :(
Yup patience and loading. This is my second time round with achillies tendonitis. Trust the process.
@@austinsteiner5822is the achilles tendonitis the same as quadtricep tendonitis? Like do i or we follow the same rehab program? And 5 months after how you feel now? Sorry i asked to much here but would appreciate every answar!!
Excellent speech.My experience show that you are absolutely correct.Gradually move and load the tendon is extremely helpful.However when there is pain.It makes things much more difficult.Do we have to take painkillers to reduce the pain before we embark on our exercise.
Very good question. Yes I believe also in movement helps greatly. Gradually, step by step, you can built up your refreshed oxygen network, which on its turn rebuilts other internal connections. ♥️
I wouldn't. Pushing through pain and overuse is how people get these problems in the first place.
@@Spreadlove5683 Yep. The general idea with training tendinopathy is to keep the pain at a score of 4 out of 10. That's a healthy limit
Is urs ok by using these
Jill Cook, Ebony Rio, Tha GOATS
o very interesting and informative. I am a very active, my husband is partially sighted, our eldest daughter is Spina Bifida and our youngest daughter has autism. I am thrilled to hear that rest is not recommended to a great degree - how can I rest? I am a light sleeper, I never nap and am always using all my spare time sewing and doing crafts. So.. I can keep my lifestyle (no option really) in the knowledge that movement and loading is actually adding to my rehabilitation. I always maintain that mobility is the source of a long life!! thanks
thanks so much
Great vidéo. Thanks!
there is no consensus on this, keith baar team has a different opinion on the donut/hole thing
tendons are more vicious than frozen shoulder, shoulder bursitis, cubital tunnel- i have elbow tendinitis and tendons are evil- i wanna die ----
Dr Cook, Thank you so much. Please tell me - how do you feel about cold laser therapy?
This is great news, thank you very much. :-)
Thank you
this is gold
What does it mean to add 'compression/compressive' loading?
U can compress a tendon by stretching the antagonist muscle
Compressive forces occur in tendons where the tendons pass bony protuberances. During specific movements, the tendons become compressed against these bony protuberances.
I want to say 'knees-over-toes' style of exercises would be compressive loads. This is why they are stage 3, yet some people go for these very early in their programs.
@@johngiovanni6045 what does that mean? I currently have a distal bicep tendinoopathy and have been doing isometric bicep curls for 45 seconds, working my way up weight every 2 weeks or so (as well as bicep and upper forearm self massaging). In my case what would it mean to add compressive loads/ forces? Does that mean to get a band and wrap it tightly around my bicep tendon to increase blood flow? Or is it a specific movement pattern that the term 'compressive forces' refers to?
I wonder whether my amplified AuDHD is causally related to inflammation and recent post-exercise tendoninopathy .... (the added wrinkles are that I had a complex medial meniscus tear on the same (right) leg which took many years to get basic function post-surgery and that a decade of undiagnosed hypercalcaemia led to some extra weight (≈20 kg more than my usual running weight 25 years ago).
What if I already rested it for 7 months alrdy ... Fk my docs, gave me only wrong advice
What does she mean by function?
Unfortunately this isn't supported by the experience of patients. Many people with tendonitis eventually develop partial or complete tears in the tendon, going into a downward spiral of tear, regrowth, and re-tear. I wonder if this team has been selectively choosing their patients.
Love it!
Is there some loading program for the elbows? I have all 4 ( biceps , triceps, extensors and flexors calcification)?
is it possible that high lactic acid caused by high intensity and high volume training will support cell healing.
It's well known that typical bodybuilding training higher reps to failure help with joint pain. maybe it also help the tendon.
What means “ rest the day “ ? Should do absolutly nothing and lying in bed or Can i moving lightly like walking outside . No Long distances .
walking is very aggrevating. When I started paying attention to my phone's pedometer, regonized the pattern that at about 4,000 steps, it triggered discomfort. Instead, use an indoor bike, not just lying on the couch. Sit on the floor, change positions, etc. Be mobile, just not constantly walking.
In the min 11th she talks about how shockewave reduces pain? By inducing damage to the nerve? Is this right? Or I'm misunderstanding her?
Please help
Please, tell me whats mean "outside of compression"?
Outside of compression is meaning no compression on the tendon. So in a squat, when you’re going into deep knee flexion at the bottom of the squat, the quadricep tendon is in compression.
If bad tissue never heals and we should focus on the good tissue, what prevents the bad tissue from keeping developing?
What about stem cell treatment?
hola. tengo una duda mi ingles no es muy bueno. las tendinopatias mejoran con ejercicios excéntricos y ejerccios Isotónicos?
Ella dice que sí, pero son limitados. Esas son fases de inicio
). Os exercícios de fortalecimento excêntricos do quadríceps são os mais usados nos processo de reabilitação, apesar dos resultados do trabalho de Cannell et al, que compararam exercícios excêntricos com concêntricos e em ambos os tratamentos encontraram resultados favoráveis em relação à dor e ao retorno ao esporte; houve ligeira tendência de o retorno ao esporte ser mais comum nos pacientes que foram submetidos aos exercícios excêntricos(60). O fortalecimento excêntrico do quadríceps parece aumentar a atividade metabólica, incrementando a síntese de colágeno tipo I
This information is in this text (in Portuguese)
www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-36162008000800001
I don't speak English nor Spanish... If you don't understand Portugues, use the Google Translate to help you = )
so prp is actually dangerous?
Hi Everyone, I'm not sure to understand, is eventually the damaged part of the tendon replaced by healthy tissue? Or will the damaged tissue always be there...?
I believe it will always be there due to the collagen fibers not rearranging properly
@@wvyabhi But did I understand correcrly that your are most likely to have, along with the damaged tissue, even more healthy tissue than a normal tendon?
@@guyw1thbeanie yes but you'd have to rehab and strengthen it to get to that point
@@wvyabhi Oh ok, I get it, thanks. Also, I didn't quite understand what she meant by compressive loading. I personally have a distal bicep tendinopathy (not sure what exaclty but it's not a rupture and there's pain right at the elbow and surrounding areas including the upper part of the forearm). Would compressive loading mean doing the rehab im currently doing: bicep curl isometrics but with like a reistance band wrapped somewhat tightly around my bicep to 'compress' it and increase bloodflow? Or is compressive loading/ forces something else in my case?
@@guyw1thbeanie Oh I see. i'm not an expert at all so you should probably work with a physical therapist, but i don't think compressive loading refers to compressing the tendon literally with a resistance band. i think you would probably be making it worse since you're restricting / affecting the range of motion.
it's good that you don't have a rupture, but i would take it slow and make sure to combine isometrics with high rep (but challenging) eccentrics. this is how i got rid of my tendonitis. it takes time, but there will be blood flow
How is it that the ends of the Achilles tendon are in compression when the foot is in dorsiflexion? It would seem like the whole tendon is being stretched out, not compressed. Also, are energy storage loads present when the tendon is in compression or when it is being stretched? For the Achilles tendon, would this correspond to the foot being in plantar flexion?
I guess when the heel is raised, the calve muscle is constricting, which could stretch the Achilles tendon (aka energy storage load I think), but I don't completely understand how when the heel is lowered, the Achilles is in compression. Like, maybe the calve muscle is stretched out and pushes the Achilles tendon into compression? I would think both the calve muscle and Achilles tendon would be stretched out. I guess maybe not.. maybe the muscle and tendon are always in opposite states to one another.
@@Spreadlove5683 Because your heel, the Os Calcaneus, presses against the achillestendon in dorsiflexion
Is she saying you can't tear a tendon? My tendon disagrees (i think)
I think only kitesurfers will watch this video
I have tendinitis in my knee (LCL) from biking alot and not matter what I do I cant cure it. Cold compress rest etc. When I walk alot or bike it hurts. It has gotten a bit better. do you know what I should do?
Bike more. Find your range, tolerance and keep pushing it in bursts. Rest in between with heat to increase blood flow
Heavy resistance training is your best friend. Cardio destroys your connective tissues, strength training build that up
Ok so my pec tendon hurts what do I do ? physiotherapy isnt working and Ive been injured for 3 months.
So if the tendon tore came from wear and tear and maybe heavy lifting, wouldn’t the same activity cause it not to heal? And maybe even make the tear worse?
With the right amount of load it will heal. The body will adapt but you must give it the right amount of stimulus to do so. Too much stimulus and it will get worse.
And the worse is when what caused the lesion was work, but still you have to work with your arms and hands( in my case) , or whatever they work with. Even when you try to , repetitively factory work doesn’t help.... I am writing this hoping people can be warned and take better decision if possible ( not always, it seems to us that we have too much choice, specially in economical crisis times).
Sports? Unless your profession is sports, the rest of people shouldn’t abuse their bodies.
this shit old