(because it\u2019s not a typical inflammatory condition)<\/p>\r\n
It\u2019s important to know this because the Rest Ice Compression Elevation (RICE) protocol does not<\/strong> <\/em>apply to a tendinopathy<\/p>\r\n (it actually makes it worse)<\/p>\r\n Even if it was<\/strong><\/em> a true inflammatory condition like an ankle sprain… it\u2019s important to note that ice is no longer indicated<\/p>\r\n (Read here<\/a><\/span> to see that even the original proponent of ice has retracted his position)<\/p>\r\n And rest?<\/p>\r\n Rest decreases the load tolerance of a tendon<\/p>\r\n<\/blockquote>\r\n [after 2 weeks of rest a tendon starts to lose it\u2019s stiffness and strength and which makes the condition worse in the long run]<\/p>\r\n Tendons are a Goldilocks workload management thing:<\/p>\r\n I would say never rest a tendon, never. You can always do isometrics.<\/p>\r\n<\/blockquote>\r\n – Dr. Jill Cook, one of the world\u2019s leading experts on tendons.<\/p>\r\n So the key for reducing pain in my Golfer\u2019s Elbow was 3 key things:<\/p>\r\n Rather than rest completely, I started using Ebonie Rio\u2019s protocol<\/a><\/span> for isometric exercises.<\/p>\r\n 5 sets with a weight that I could just<\/span> hold for 40-45 second holds with 2 minutes rest between sets<\/p>\r\n<\/blockquote>\r\n This has been shown to:<\/p>\r\n Now, I could have stopped training BJJ or Judo altogether…<\/p>\r\n …but instead (once the initial pain settled) I modified my approach.<\/p>\r\n Here\u2019s some ways I reduced aggravation of Golfer\u2019s Elbow when training BJJ and Judo:<\/p>\r\n [I\u2019d still get a little pain the next day, but nothing like it was]<\/p>\r\n Once the initial flare-up had settled, it was time to introduce a progressive loading program<\/p>\r\n The key principle here is that you can\u2019t fix the areas of tendon degeneration…<\/p>\r\n …but with a good progressive loading program you can strengthen the remaining good tissue so that you\u2019re even stronger than when you started<\/p>\r\n [this research<\/a><\/span> has shown that even if you have tendon degeneration you end up with more good tissue than when you started]<\/p>\r\n When it comes to tendinopathy you treat the doughnut, not the hole<\/p>\r\n<\/blockquote>\r\n The goal of this phase is to develop muscle and tendon strength BUT adjusting programming to take into consideration the underlying pathology<\/strong><\/p>\r\n But here\u2019s a point I cannot emphasise enough:<\/p>\r\n It\u2019s not just about the specific exercises… it\u2019s about how they are programmed to achieve specific effects<\/p>\r\n<\/blockquote>\r\n If you give someone an exercise to do without programming it using the FITT principle it\u2019s like giving them a chair that only has one leg<\/p>\r\n (or telling someone to take medication without giving any info about the dosage)<\/p>\r\n So here\u2019s the detail:<\/p>\r\n We don\u2019t get stronger when we exercise…<\/p>\r\n …we get stronger IF<\/strong> <\/em>we give our body an appropriate<\/strong> <\/em>dosage of stress AND<\/strong> <\/em>then allow adequate time for rest and recovery:<\/p>\r\n It\u2019s in the downtime that we adapt and grow back stronger.<\/p>\r\n [constant stress damages, intermittent stress strengthens]<\/p>\r\n For tendons, we need to give them 48-72 hrs between sessions:<\/p>\r\n This also gives an opportunity to monitor whether our intensity is appropriate\u2026<\/p>\r\n You get stronger by lifting heavy weight.<\/p>\r\n But:<\/p>\r\n Tendons don\u2019t like change. Our goal here is to back things off and then sneak back up on it.<\/p>\r\n<\/blockquote>\r\n So here I started at a load that I could just<\/strong> <\/em>lift for a maximum of 15 repetitions before failure (15RM)<\/p>\r\n It was then a case of slowly<\/strong><\/em> progressing to a 6RM load over the course of a couple of months<\/p>\r\n [it\u2019s worth noting here that pain during lifting is to be expected]<\/p>\r\n So how did I know when to progress?<\/strong><\/p>\r\n If there\u2019s no big increase in pain 24 hrs after a session that\u2019s generally a sign that the weight is okay…<\/p>\r\n …and if pain increases 24 hrs afterwards then this should initiate a reduction in weight<\/p>\r\n (as this is an indication you\u2019re overloading the tendon too much)<\/p>\r\n But:<\/p>\r\n It\u2019s important to note that this was done in conjunction with another variable…<\/p>\r\n In this context, time relates to the total number of work sets:<\/p>\r\n I started with 4 work sets per session and built up to 8 sets per session<\/p>\r\n (that\u2019s around 12 – 18 work sets per week)<\/p>\r\n Key point:<\/p>\r\n I never changed both weight and sets in the same session… one variable at a time. <\/strong><\/p>\r\n The 2 exercises I incorporated into my rehab were:<\/p>\r\n Strength training creates a good foundation… but rehab should not stop there:<\/p>\r\n To decrease the risk of re-injury (or a different injury) there needs to be a step-by-step graded exposure and loading program that mimics the demands of the sport you\u2019re trying to get back to.<\/p>\r\n<\/blockquote>\r\n So now we\u2019re at Step 3 of the graded exposure program for BJJ or Judo<\/a><\/span>: Solo drills that replicate the demands of grappling<\/p>\r\n In the case of tendons it\u2019s all about rebuilding their capacity for energy storage and release<\/p>\r\n (healthy tendons act like springs)<\/p>\r\n So this consisted of adding in 3 movements:<\/p>\r\n To replicate BJJ and Judo gripping actions I used a set of these Scramble Grip Trainers<\/strong> (affiliate link here<\/a><\/span>)<\/p>\r\n\r\n
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1. Removing high, fast, or unpredictable tendon forces.<\/h3>\r\n
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2. Manageing load<\/h3>\r\n
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3. Modifying activity<\/h3>\r\n
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2. Improve strength in the muscle-tendon unit by using heavy slow resistance training<\/h2>\r\n
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1. Frequency<\/h3>\r\n
![\"Rehabiltation](\"https:\/\/rollingaroundbjj.com\/wp-content\/uploads\/2020\/12\/Rehabiltation-of-Tendons-in-Golfers-Elbow-in-Grapplers-Exercise-Effects-on-Collagen-Synthesis-and-Degradation.png\")
<\/p>\r\n2. Intensity<\/h3>\r\n
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3. Time (Amount)<\/h3>\r\n
4. Type<\/h3>\r\n
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3. Functional rehabilitation incorporating spring-like loading<\/h2>\r\n
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![\"Get](\"https:\/\/rollingaroundbjj.com\/wp-content\/uploads\/2020\/12\/Graded-Exposure-for-Returning-to-BJJ-or-Judo-After-Injury.jpg\")
<\/p>\r\n\r\n