I recently got a great viewer question about why we want to load our injured tissue and why we do it with eccentrics. I think that's a fantastic question because if we don't know the research behind it, it seems counter-intuitive, especially when all of the advice we get is “rest”. Intro (00:00)
Video Overview (00:26)
The Science Behind It (00:48)
Research (01:48)
Eccentric Guidlines (02:34)
Final Notes (05:19)
Outro & Bloopers (05:47)
So let's talk about why we load injured tissue and how we know how much load to do!
"Repetitive healthy loading, as in exercise, can promote remodeling in the tendon, leading to long-term structural and functional improvements. The process of tendon remodeling involves both synthesis and degradation of collagen with a net degradation that begins immediately after exercise and then shifts to a net synthesis." (Andarawis-Puri)
Essentially, what we are doing is loading the tissue in a SAFE manner, to create physiological demand on the tissue that forces the body to adapt to these changes. We want to increase the workload or work capacity of the muscle group. Unlike the activity we were doing to hurt the tissue, this type of loading is designed to help and remodel it.
Sometimes this is straight forward. If a muscle group is weakened or not well cross trained, it may not be able to handle the forces you are placing on it. For example, if you never train your wrist extensors, they may not have adapted to your climbing demands and cannot handle the loads you place on them with climbing whereas your flexor group might be perfectly capable of handling the same load. Basically, group A can tolerate this really hard activity while group B cannot, eventually this leads to group B burning out.
Sometimes it's tougher like with a wrist flexor issue. We already load that ALL the time when climbing, so why load it more? Well that's when we need to be even more specific and work on eccentrics to help with tissue remodelling.
Eccentrics
An eccentric contraction is the lengthening of a muscle under load. Concentric would be shortening under load. So why do I always stress eccentrics? Well, in rehab terms the evidence shows that eccentrics can help improve tendon remodeling which promote strong cellular structure of the tissue which improves strength and will speed up your healing time frame. While there is good research to support those, I would be biased if I didn’t mention that there is some research that shows it doesn't do more than regular strength training. So, on one hand we have evidence showing that it does help tissue, and on the other it shows that it is not more effective than regular strength training. So essentially we can view this as a high benefit low to no risk method of training. It is likely to help your healing while it is not likely to cause damage or be a waste of time.
The hold
I've also mentioned a hold before. The hold occurs at the end of a concentric contraction, so at the shortest length of a muscle and tendon. The reasoning behind this is to push out the neovessels that have inappropriately invaded the tissue. Often times when we have a chronic issue, we have disorganized healing and the invasion of said neovessels. This can actually slow the healing process so the hold functions to improve and restart the healing.
Rest (30 seconds)
I often recommend only a 30 second rest between sets because there is research that shows an increase in release of certain hormones and chemicals with a shorter rest periods, in particular, 30 seconds of rest. If you are rehabbing injured tissue, this is clearly ideal. On the other hand, if you're training for strength or power you may want a longer rest, but we are looking at this as a healing method.
Repetitions (8-12, fatigue)
Now the hard part is repetitions. 8-12 is a great range to gauge the weight you're doing. You shouldn't have pain with reps in this range but you should feel muscle burn. If you're not feeling this then you won't be getting that good release of hormones and chemicals and you're not optimizing your healing. So if you are up to 16 reps and feeling no burn OR pain, increase the weight. If you have pain or a burn at 4 reps, drop the weight down.
Keep in mind, if you're doing the 30 second rest protocol, the reps may drop. You may start with 10, then only get 8 the second set and 6 the last. That's normal and acceptable, as long as you are stopping due to fatigue/burn and not due to pain. If you have pain and that's stopping the reps, lower the weight and listen to your body.
When?
It is important to know when to load the tissue. You should not do this when there is significant pain or when you JUST injured the tissue. That is when the PRICE protocol should be employed....
For the rest of the show notes including the references, please visit RockTherapyPT.com/blog
Jason Hooper, PT, DPT, OCS, CAFS
IG: @rocktherapypt
Filming and Editing by Emile Modesitt
www.emilemodesitt.com
IG: @emile166
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