Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby, and we're talking bodies. How you doing Iyad?
Iyad: Doing well. Let's talk some bodies.
Mark: So tendon pain with jumping sports. How do you deal with that?
Iyad: It's pretty common that we see people who play a lot of jumping sports in clinic and often they have aches and strains all over the place. And I mean, most athletes that we deal with are usually managing an injury or two through the season because by the time they come and see us, it's kind of been persistent and they're just kind of patching it up as they go.
So one of the things that we've been seeing more recently, especially as we get closer to kind of the nationals and the provincials where we see kinda an increase in people's schedule and their training and their volume of jumping, we start to see a little more tendon pain and tendon dysfunctions with these people.
So this isn't just necessarily one type of tendon cuz it could affect their achilles tendon or also their patellar tendon, which is the tendon at the front of the knee, under the kneecap. And we rely on those two structures very heavily when it comes to jumping. So, you know, part of the things that we would have to kind of do, and this is the challenge here, is managing mid-season versus, let's say in the off-season, where we can completely take them out of that aggressive, provocative program, build them up, and then send them back in.
Which we would never do that way anyways because we don't wanna cut off jumping entirely if they could still tolerate it. But ultimately, what we have to do in, in season is really be mindful of the total volume of things they do and their training program and kind of tinker with that. Maybe substitute some exercise and some different programming aspects, and then maybe also try to shore up some areas where they might be a bit underserved. So that we can kind of help support that sore spot.
So a common one we'll see is in adolescent boys. We'll see this a lot. Just the the patella tendon, which is the front of the knee. We'll see a lot of people in volleyball. If you ever go to a high school volleyball game and you'll see people like knees with a little kinda strap that's just across the kneecap. They do that for relief, but those tend to be kind of like a primary demographic. Basketball, volleyball, and sometimes soccer. Anything where you're involving like repeated jumps or just like high intensity sprinting, you'll see some of that stuff happen.
Mark: So, I guess the symptoms or pain, what's causing it? Just overwork?
Iyad: So a few things can cause this, but tendons are really funny. They're very finicky structures. They kind of like a nice consistent program. And then whenever you kind of go through a period where you disrupt that by like rapidly spiking the volume. It can happen. The funny thing about it is it doesn't just happen the next day. Basically what happens is I could ramp up all of a sudden and it could show up a few weeks later because I just don't have adequate recovery time in between that, to go back to where my baseline was. And then eventually tendon just reaches a threshold where it just becomes too sore.
And one of the things that people will complain about is, actually funny story, is we worked with a volleyball player last week, and his main complaint wasn't the pain, because he could play through pain, it was the fact that he can't jump high anymore. And he's lost some of that kind of explosiveness that is associated, like, you know, especially when he's blocking off a volleyball, where he has to jump up and create a full reach.
You know, he said, oh, I can't jump up anymore. I have to kind of really think about it and have to really, really kind of like dial in. And we were able to kind of assess him and based on what we saw, it was basically part of the process was that his pain was so significant on some days that he just can't even kind of recruit that muscle adequately in his cap.
So we had to kind of really tinker with this program and, you know, we kind of set some priorities, for example, for him to, to play in the big tournament coming up. So we kind of monitored restraining and kind of modified some of that to kind allow him to go and play in that tournament. And he ended up responding really well to the program, to the exercise program. And we just did it in a way where we just didn't only jump. And I think that's really, really important that we kinda like do the rehab along with some of the movement that we wanna do.
Mark: So one of the things that I learned, and I don't know if this is true, it was that the muscles will increase in strength and ability to respond to hard work, far faster than tendons will.
Iyad: That's probably accurate I would say. What I can tell you is the specifics of like, what's the dosage that you need and how much time. We just know the tendons tend to be slower in adaptation. They're quite strong structures. So what I'm trying to say here is not to freak people out and say, oh, don't ever jump, because your tendon's gonna, they're quite strong.
And they're quite resilient structures and often the fix is just more training, but just more specific training to kind of help improve, let's say, the capacity of that tissue to be able to handle all of that volume of jumping. And what we see a lot of times, especially in the adolescent population or maybe like kind of like the late teen population is, some of them absolutely love to do their jumping training and their training on the courts, but they absolutely neglect the strength side.
And that's kind of where we come in and try to like really help them on the strength and conditioning side to help, not just with the Achilles itself, but you know, when you jump it's a whole body movement. So people we've worked a lot on, kinda how their trunk, how their body stacks up over their hip, hip over the feet kinda thing.
And then also like you wanna build the areas that are potentially gonna help you put all that force into the ground so you could pop up. So yes, they are slower adapting, but the good news is they are very adaptable structures.
Mark: So when you're diagnosing this and it could be whichever of the places that are causing an issue, how are you determining which beyond pain?
Iyad: So it's really simple actually. With tendons, there's a few rules. One of the things we see in the Achilles, for example, or in the patella tendon, is it's very localized. It tends to be about a finger width in area. Nothing more than that. So when somebody comes in and says this whole thing hurts, it might not just be the tendon.
It tends to be quite localized and pinpoint, and it also tends to be repeated because we aggravate it with repeated activity. Now most tendons will be worse upon starting the activity and kind of warm up a bit and then creep back up in the end. So that's kind of the pattern you'll see, with the runners will say, yeah, I start my run. It's kinda rough. And then it gets easier and then it gets worse later on. And then the other thing that happens with tendons is they kind of have that delayed response. So 24 hours later or so, people wake up and they're like, well, I actually feel really sore. I couldn't put too much weight, I couldn't jump as much. I couldn't kind of exert the area as much as I did before. And they often wonder if they slept upon it or anything like that. But it's really more of a product of doing too much, you know, the day or two before that.
And then finally when we test it, it's really funny. Most people assume that the diagnosis happens by imaging and the diagnosis is a clinical one. So we do a clinical kind of cluster of exams, and what we would usually see with tendons is, if I make you do let's say a loaded activity to the tendon that's exerting it by, let's say this much and then I give you something that exerts it by this much, the more we go up and load, the more pain you're gonna have or the more discomfort you're gonna have.
So that's typically how that system works. So we kind of try to kind of do that sequencing cause we know what movements, for example, could be really, really high stress and what movements are really low stress. And based on all of those things together, we can kind of figure out, plus the pattern tell us like, oh, it hurts at 20 minutes of my run, or 30 minutes of my run. Or after intermission I usually feel it like, you know, when I'm coming back on the court. Those are kind of things that, you know, we use to put together to figure out what's that irritability level, so how much can this person handle? And that's also what's gonna dictate how aggressive we could be in their training.
Mark: In the course of treatment, was it just, I imagine it's not just laying off. If someone's in the middle of a workout or a competition season, how do you treat this?
Iyad: So the cases where we would lay off are pretty rare, I would say. Most often we would kind of modify the program first before we lay off completely. Obviously in cases where like there are times where we lay off for a day or two. That's kind of like, what it tends to be is we would just modify that program afterwards. We would wanna look at all the things that provoke it. So sometimes it could be habitual friction or rubbing.
So for example we had a hockey player once who developed it and you know, he just got new skates, not broken in, heels digging right into his Achilles tendon. So that got really, really sore. So we just got him to skate in his old skates while he was rehabbing. And then we actually made him do a breaking in program for the news skates where he would just wear them kind of for warmups and that's it. Just to kind of loosen them up a bit.
And then with that, we were able to train him up to the level that Achilles tendon could handle, like the pushing off. Even though hockey's not considered a high achiles tendon activity necessarily, it was still quite aggravating for him whenever he would stride out and kick his leg to the side. So that was kinda one of the things that we kinda would have to do.
And we would also really wanna exercise, like that's primarily the fix here. It's not just exercise the local area, exercise surrounding musculature, make sure they have adequate mobility in some of those areas.
So for example, if you need to be able to squat really low or your ankle is really stiff, well that's gonna be a little more difficult to do. We tend to kind of look at the ankle underneath the hip in that case to be able to kind of carry that movement forward. But then also, I think what most people will do, is focus on that rest of the chain and forget the actual tendon itself. We really need to address the tendon. So it's a case for local intervention and also let's call it the distal and the proximal area too.
Not just the, oh yeah, just hit the knee and you'll be fine. Or not just hit the area around it and the knee will be fine. So you kinda have to like look at both. And then it's really a matter of building up tolerance from there. So we would start with managing minutes and we would never stop hundred percent, tends to be a last resort for us.
Mark: If you're having tendon pain from your jumping sport or running, sprinting, whatever, the guys to see are Insync Physio. You can book online at insyncphysio.com, or you can call the office to book. (604) 298-4878 in North Burnaby. They also have a Vancouver office at (604) 566-9716 both are available to book on the website. Thanks so much for watching and listening. Thanks Iyad.
Iyad: Thank you.