Hi Everyone Rehab safely. Mr. physio here today I will do my first Q and A video to address the most commonly asked questions in my channel I’ve picked five questions that I think are most important in terms of tendon Rehabilitation and I will answer them with some evidence behind. My answer is no there is why in my first video, but I will tell you briefly again tendons attach muscles to bones. And their main function is to maintain muscle length and tension also, they transmit its elastic force between muscles and Bones. That’s why muscles can work. Just like a spring. But if you put a prolonged stretch on tendons it starts to lose its elasticity meaning they can function properly and breaking down and tearing. My answer based on this study is no J. Cook is one of the pioneers in tendon rehab who has published many papers including this recent one in this study the author say the extent presence of blah blah blah. What? the main point here is they even used the word ‘futile’ for those treatments directly targeting damaged tendons like a friction massage electrotherapy and shock wave therapy whatever you name it and this is ultrasound. Imaging where you can see the damage tendons as a black hole. So basically what they’re saying is treat the donut not the hole you have to treat what’s left rather than just so obsessed with what’s already gone. This answers my third question other modalities are effective? again not really although the original Continuum paper suggests blah blah blah blah what they mean by the original paper here is the one published in 2009 what they mean by the original paper here is the one published in 2009 where they believed treatments directly on painful tendons can help regenerate the damage what they are saying now is after 10 years of research. They don’t support their previous opinion anymore. whatever treatments you are doing on the actual tendon are old so 10 years ago it was believed to be effective. But now it’s not once damaged it’s less likely the tendons can be repaired. So let’s not hope if you can regenerate that damaged tendon rather We have to train the healthy part of the tendon that’s still left to us. it is also true even in healthy people This is a systematic review from berlin, Germany. Changes in tendon stiffness are due to adoptations of the material(donut) morphological means structural. So the structure doesn’t change in shape. The hole doesn’t get repaired rather the donut. adapts to take more loading and get healthier and the other and the adaptations can occur through mechanical loading, which is exercises. First of all, let’s have a look at these three types of muscle contractions. The first one is concentric contraction where your muscle gets shortened when generating power and second one is eccentric contraction where your muscle gets lengthened while generating power and the last one is isometric contraction where your muscle length doesn’t change when generating power there are many evidence about the effects of eccentric exercises in tendon rehab. But there are also some suggesting the type of contraction doesn’t matter and the key principle is to find appropriate loading for each individual and progress accordingly. However to make a normal Progressive loading effective you need a heavy loading intensity which can be quite hard. If you don’t have any access to weights or simply just not familiar with weight training so it’s my personal choice to show more eccentric exercises because I believe It is something you have more control over and very easy to do anytime anywhere, but still effective with all the principles and evidence I’ve just mentioned applied. I’m trying to show you the simplest exercise because I’ve seen many many people not doing exercises because it’s just too complicated therefore my recommendation always starts with muscle massage and isometric exercises to reduce the initial pain. And then you introduce eccentrics on top of waiting until your symptoms get better enough to do weight training or Plyometrics. Whatever for the next level Monitor your pain for 24 hours after exercises Cook said tendon talks to you 24 hours later which means if you irritate the tendons with exercises, they can react 24 hours later. So when do the exercises your pain level should be below 4 out of 10 with 10 being worst pain, but if you feel a new pain or increased pain during after exercise or even in the following day. You should go back to your previous level of exercises with frequent ice on painful tendon muscle massage and isometric. And then give it a go again to increase your loading little by little. one thing the researchers are still trying to find is the appropriate loading for each individual because everyone is different so you shouldn’t do too much. You shouldn’t do to little…so find it yourself or find a professional who could help you through your long journey because you may need to address other biomechanical issues. So that’s the end of my first Q and A video and I’m thinking to do more videos about tendon Rehabilitation. Thank you for watching rehab safely.