Adaptations to Training
When we “use” our bodies, our bodies adapt to the activity we are doing. The more we do, the more we are able to do. The less we do, the less we are able to do. This is essential in eliciting a training response.
When we train we want to cause stress to our body. (This may be our muscles, bones, cardiovascular system, etc.) We want to overload the system, which causes a degree of damage or micro-trauma. The body then responds by growing bigger / stronger / faster / fitter, so it can cope with that load in future. We cause stress to force adaptations.
Stress/load => damage => rest/recovery => adaptation/growth.
A lot of common gradual-onset injuries result from a failure to adapt to load.
There are a number of variables that can be multiplied to determine the total load:
The intensity of the activity is the most powerful multiplier in this list.
When we are considering total load, we also need to consider variables that make it harder for our bodies to adapt to load.
Variables that can be multiplied to determine how well we adapt to the load:
Recent research found that getting less than 8 hours sleep a day almost doubles the injury rate in athletes.
I’ve been frustrated this week by a couple of patients with Achilles problems that I thought should recover well. They’ve disappeared to go and have an injection, against my recommendation. It’s made me think about whether or not I should have made the referral myself? What are our options for injections, and do they work?
There are a range of commonly prescribed treatment options for tendinopathy, but very few are supported by quality, randomised, prospective, placebo-controlled trials.
SO WHAT DO I DO?
WHAT ABOUT INJECTIONS?
There are a range of drugs to inject into or around a tendon, depending on who you are referred to:
- Corticosteroid (A strong anti-inflammatory)
- Prolotherapy (An irritant to stimulate new tissue growth, e.g. hypertonic dextrose/glucose)
- Sclerotherapy (An irritant to decrease vascularisation, e.g. Polidocanol)
- Traumeel (A homeopathic preparation derived from arnica)
- Actovegin (derived from calf blood)
- Autologous blood (injecting your own blood into the tendon to promote healing)
- Platelet-rich plasma (blood is taken and PRP is extracted and injected to promote healing)
- High-volume injections (to damage the tissue and encourage new growth)
PROLOTHERAPY / SCLEROTHERAPY
AUTOLOGOUS BLOOD INJECTIONS
PLATELET RICH PLASMA (PRP)
WHY DO THE INJECTIONS WORK FOR SOME PEOPLE?
REGRESSION TO THE MEAN
Injections are a powerful way to administer a placebo effect. You need to see a specialist to receive it. You need to pay more money. There’s some high-tech equipment spinning the blood. Everything is set up for you to expect improvement and, in a decent percentage of cases, that’s all it takes to get better. If you believe the injection will help you then it is much more likely to work. However, the research tells us it doesn’t really matter what substance is injected, it is your belief in whether or not it will help that is the variable more likely to determine the outcome.
Have you had an injection for your tendon?
Eccentric exercises have been commonly prescribed over the last decade, following the pain-provoking Alfredson programme of 3 x 15 reps, twice/day. It sometimes works very well.
The last few years I’ve favoured isometric exercise as an initial treatment - partly because of personal experience with Achilles, patellar, and lateral elbow tendon issues, & recommendation from Jill Cook & Craig Purdham at the AIS.
The research protocol uses 5 reps of a 45 second contraction, at a 70% effort. I prefer a more gentle contraction of 50% effort, but a longer hold of at least a minute, and I like a larger total volume of at least 10 minutes/day. Obviously it’s hard to define what the perfect dosage is for exercise, & volume could be adjusted depending on results.
I like isometrics because:
- you don’t need any equipment / you can do them anywhere
- they're easily done for all the common tendinopathies
- they can be started straight away, even in the most painful cases
- they work well