Stretching: the truth

In clinic, I will often do a treatment and incorporate some stretches to enhance the effect of the work done on a client. And it feels sooooooo good to be stretched!

But what is it I am trying to achieve?

Why do people incorporate stretching into their exercise program?

What are the benefits of stretching?

Well, there are different types of stretching and in clinic these are used for different purposes. Some examples are listed below.

Fascial stretches: can be long slow holds for a duration of 90s, which try to encourage and lengthen stuck connective tissue called fascia or it could be quite quick movements by the participant to help the fascia to respond under dynamic stress. Individuals often use a foam roller at home or in the gym to help with fascial stretching.

Passive stretches: where a stretch is held for 15-30s. These are great to help soft tissues, perhaps after trigger point work, and give that feeling of lengthening and opening.

PNF (Proprioceptive Neuromuscular Facilitation): Originally devised to help people with stroke recover movement and strength this encourages a client to resist a stretch for a short period of time but then allows the muscle to stretch to a greater degree once the resistance has stopped.

Active Isolated Stretching (AIS): A repetitive stretch that takes the muscle through its full range of movement and only holds the stretch for less than two seconds during which gentle overpressure is applied to enhance the movement before restarting. The repetitions help build stamina and strength.

Soft tissue release (STR): I have included this here as it is a technique I use in clinic to help stretch a muscle and is often used after trigger point work or to help release tension in big muscle groups such as the hamstrings or quadriceps. A muscle is contracted then pressure is applied at a point on the muscle and holds whilst the muscle is stretched. This again is a series of short, quick movements that is repeated at several points along the muscle.

Dynamic stretching: This is usually focused on sport specific movements where you start taking the muscle into a stretch gently and work to increase it taking it though the full range each time.

Ballistic stretching: This type of stretching lost popularity for a while as people were taking it to extremes, basically you take a muscle into a stretch then ‘bounce’ within a short range at the end of the stretch range. You are trying to increase the stretch each time but caution must be used as this type of stretching can lead to injury so it is not advised unless you really know what you are doing!

In addition, stretching as part of a warm up prior to exercising has been shown to reduce the risk of injuries, particularly in impact sports. Again, the type of stretching is important. For example, passive stretching can improve flexibility but decrease power for 30 minutes post stretching, this might be good for gymnasts and yoga practitioners but not so good for weightlifters and rugby players. Dynamic stretching is a useful warm up for many sports that involve sprinting, such as football. A good summary of the different types of stretching and the factors to be considered from a massage therapist perspective can be found in the book Massage Fusion(Fairweather and Mari, 2015:pp.157-176).

However, the evidence for stretching post event is inconclusive. What is highlighted is how people perceivestretching helps them: it is part of their cool down, enables individuals to feel they are getting rid of muscular tension from their chosen activity; helps them to feel realigned, it is part of their psychological de-stress from the activity; it has meditative effects; it prepares them to calm down the autonomic nervous system, etc.

This might also explain why some people do not feel the need to stretch after an activity.

Hopefully you can see from the variety of stretches available that there are different goals when using them. The main benefit is always to feel that the soft tissues feel lengthened. Stretching can be used to increase flexibility, to improve strength, to prepare muscles to work optimally under stress and to assist with proprioception. Pre-event stretching minimises injury and post-event stretching has many perceived benefits.

Now this article has been written, I need to get off the sofa and stretch myself!

DOMS: Delayed Onset Muscle Soreness

DOMS is frequently experienced when you exercise at a level the body is not used to working at. This means that athletes who have upped the intensity of their training can have DOMS just as much as complete beginners who are trying to improve their fitness and strength.

Photo by Victor Frietas

But what is it?

Well, truth be told, the science world does not have a definitive definition of what is happening when the body experiences DOMS! Typically, it has been described as the inflammatory response to small tears in the muscle; micro trauma of muscle tissues; and/or a reaction to the build-up of lactic acid. All of these have been investigated but the evidence to support them is weak.

What we do know is that DOMS is muscular pain that can be over a wider area than just the muscle activated. Usually it is the action of eccentric exercises (for example, if you are lifting a heavy weight in your arms you might contract a muscle to lift up the load but you eccentrically exercise the muscle as you go to lower the weight back down) that causes DOMS to be felt. Typically, the pain is felt 24 to 72 hours after the offending activity! However, it can take as long as a week to resolve. We also know that during this period the muscle has less strength and stamina than prior to the exercise.

Ultrasound scans of muscles experiencing DOMS shows increased oedema (swelling) within the muscle fibres. There is strong support that this swelling is an inflammatory response to the trauma incurred during the exercise but it doesn’t explain the more widespread pain.

Recently, there is emerging evidence that chemicals that initiate nerve growth contribute to increased sensitivity to muscular pain when they are damaged. This substance is referred to as Nerve Growth Factor (NGF). It is the nervous system that causes muscles to contract as the nerves attach to various parts of the muscle cell at neuromuscular junctions. In addition, there are nerves that provide sensory information such as heat and pressure.

What if eccentric exercise damages the nerve endings as well as the muscle fibres? This would then release NGF into inflamed muscular tissue possibly causing additional reactions to occur.

The nerve and muscle relationship: it is easy to imagine how a tear in the muscle fibre could elicit a nerve ending response

We know that the body’s normal inflammatory response takes about 24 hours to kick in (which is why anti-inflammatories are discouraged at time of injury). DOMS also takes some time to exert its effect. So as the inflammation reaches its peak there appears to be a slight timelag before DOMS is fully experienced. At the injury site the body is sending a constant flow of inflammatory response cells to the area to repair the injured site leading to increased oedema but material is also being taken away.

Could the oedema then dissipate through lymphatic channels and along fascial lines (fascia is a type of connective tissue that among other things wraps around muscle and individual muscle fibres)? This would then explain why DOMS is felt over a wider area than just the injured muscle.

But why would the body produce a response that inhibited our strength and movement albeit for a short time?

Well, in our muscles there are various types of receptors, including a type called mechanoreceptors. These receptors respond to mechanical pressure or distortion. There is evidence that NGF helps to improve the threshold that these mechanoreceptors work: effectively increasing the resilience of these receptors.

We also know that as we repeat an exercise we get better at it and can increase the intensity of the workout. Thus making the muscles being worked stronger. This would make sense in evolutionary terms and survival of the fittest approach. It would also help to explain why, when we do a different exercise using the same muscles we can still get DOMS: because the mechanical pressure and distortion of the fibres is different.

This is interesting stuff! Although still unproven.

So, although we still don’t know what DOMS is, there are some new insights into our understanding of what it is! However, it is a good sensation to experience, just be careful, for your own comfort!

Why do I still have back pain even though I do core exercises?

lumbar skeleton blue Many people who complain of low back pain are told that they lack core stability. They then embark on a series of exercises with varying degrees of success. However, core exercises alone do not always lead to improvement in low back pain. So what else could be implicated?

If you look at the structure of the back, the lumbar spine is relatively unsupported. The thoracic spine has a ribcage to protect the organs and help provide stability. The pelvis provides a framework to support the reproductive system and abdomen from the effects of gravity. However, the lumbar spine only has the protection of the soft tissues of the abdomen around it. So how does this area maintain stability given the forces that are put through the lumbar spine?

The key to providing support to the lumbar spine is intra-abdominal pressure. This is achieved through the efficient use of the diaphragm working with the core muscles of the body: namely the internal abdominal obliques, transverse abdominus and multifidi muscles as well as the pelvic floor. Together these provide a flexible corset of support for the lumbar spine, which allows the body to flex, extend, bend to one side or rotate by adjusting the support to where it is needed.

As we inhale, the diaphragm lowers into the abdominal cavity and the pressure in the abdomen increases. If we can also maintain strong engagement of the muscles around the abdomen we have maximum intra-abdominal pressure. When we exhale, the diaphragm rises into the ribcage creating more space in the abdomen and therefore it decreases intra-abdominal pressure.

If, when you are exercising and trying to activate your core, you do not think about how you are breathing then you are setting up dysfunction in your system. Just holding your breath will mean you don’t engage your other muscles properly: you do increase intra-abdominal pressure only because your diaphragm is contracted. Breathing out at the wrong time, for example when lifting a heavy weight, will lead to a reduction in intra-abdominal pressure, which means increased risk of instability in the back at a vulnerable time and possible low back pain as the muscles are strained or even worse: it causes a herniated disc or a hernia.

If we think of a can of drink, the top of the tin represents the ribs and diaphragm on the inhale – supported and strong – and the bottom of the tin is the pelvis, which is hopefully, in most people, holding the bladder, uterus and rectum from falling out. If the pressure is decreased in the tin (can is opened and drink drunk!), when pressure is applied the sides collapse as there isn’t enough support to maintain the structure.

It is much easier to squash a can when it’s internal support is gone. However, trying to squash an unopened can is much more difficult (and some might say even foolish!) because of the internal support.

That is why using your breath, together with engaging your core can be far more effective in reducing your back pain. Once you have your diaphragm working in conjuction with your obliques, transverse abdominus, multifidi and pelvic floor you are in a much better position to support your back and therefore reduce the risk of back strain, disc herniation or indeed an abdominal-type hernia.

So, do you need to focus on your core exercises to help your back pain? Ok, take a breath in and…. !

Susan Harrison is a Clinical massage therapist based in Woking, Surrey. If you would like more information or to book an appointment please email susan@powertouchtherapy.co.uk

What are the benefits of massage?

Start running

Summer running

As several of my clients are keen runners and a number of others are planning to take part in 5k, 10k or the Royal Parks half marathon, I thought it might be helpful to look at some general advice around running and self care.

For the complete beginner, the best advice I can give you is to follow a training plan. If you want to start running and the most activity you normally do is run to catch a bus then a training plan will really help you progress. Typing in ‘running training plan’ on an internet search will reveal a whole range of listings from organisations such as Running World, BUPA, Cancer Research UK, MS Society that you can follow and they all have additional advice that is relevant, whether it is about clothing, diet, motivational ideas etc.

On the training plans, it will list different levels of training (beginner, intermediate and advanced) and for example on the BUPA website it has effectively given a definition of what this means. So, when you see Monday is an ‘easy’ run, what does that mean? Well, it’s between a brisk walk and light jog, enough to raise your heart rate and get you breathing slightly heavier but you can easily talk.

For a runner at any level, ensure you have a good pair of running shoes. Many specialist sports shops, such as Sweatshop, will provide you with a free running gait analysis so that they can advise you on the best pair of shoes for you when running. It is absolutely worth investing in these, to look after your feet, to reduce impact on the body at knee, hip or even further up the kinetic chain, such as low back or shoulder level! Your shoes should be your most expensive purchase but when you look at the cost per step, it is absolutely minimal.

Experienced runners may have read about barefoot running and be interested in developing this technique. Humans have run barefoot for centuries. However, when we run with shoes on, our gait has a significant heel strike. For barefoot running the impact is more midfoot and uses a lighter, springier step. So, if you want to take up barefoot running, work on stretching and strengthening your calf and foot muscles first to prepare them for the change in biomechanics when you run.

Running injuries

There are a few injuries that runners may experience in their chosen activity. These are listed below with a quick summary of treatment ideas to help. For any severe injury you should always seek medical advice!

All the ailments below can be treated by a clinical massage therapist or other appropriately trained body worker. They can also provide additional techniques to help with swelling, reduce trigger points or muscle tightness in the affected/associated area, or provide rehabilitation advice. So if you have tried self-help and you are still not recovered it might be time to seek assistance.

Plantar fasciitis

This is an overuse injury to the sole (plantar) surface of foot. The collagen fibres near the heel have broken down and not matured properly causing pain on movement, especially after being still for a while, for example getting out of bed in the morning.

Self-massage by rolling the foot on a tennis ball or a frozen bottle of water can gently stretch the thick plantar fascia. Gentle stretches such as pulling your toes up, and calf stretches to both the gastrocnemius and soleus can be helpful. However, all stretches should be performed within a painfree zone (up to 3/10 in terms of discomfort). If you have excessive pronation of the foot, orthotics may be helpful to provide support during your rehabilitation. A massage therapist will use myofascial release and soft tissue release techniques as well as the use of heat therapy and stretches to increase flexibility of the foot.

If you have plantar fasciitis, resist running until it has improved, try swimming or cycling instead to maintain fitness and cardiovascular activity. Once you can walk briskly for 30 minutes without pain then you are ready to gradually re-introduce running into your program. Remember you are checking that the collagen fibres have matured. If you overdo it then it could be back to the start of treatment again.

Ankle sprain

A sprain is an acute injury to a ligament. Generally speaking ankle sprains are caused when the foot rolls in on itself sharply during a movement. Usually the outside of the ankle is affected. This can overstretch the ligament affecting the integrity of the joint. Active and passive movements of the joint can cause pain and discomfort. Initial symptoms may include swelling or bruising of the ankle and foot depending on the extent of the ligament damage. Treatment is immediately RICE: rest, ice compression and elevation for 24 to 48 hours. Ligaments do not have a great blood supply and can take longer to heal, a severe sprain can take 12 weeks to recover!

Ligaments that have been more severely damaged may require massage. In the very early days this may be to help reduce swelling but later stages can include techniques such as cross fibre friction which encourages inflammatory cells in to the area to stimulate the healing process.

Providing some support to the joint will be beneficial. Initial gentle movements of the foot and ankle to reduce swelling should be performed frequently throughout the day, so ankle circles every hour, pointing foot up and down, outwards and a gentle inward movement should be done 10 times about five times per day. After a few days when swelling has decreased gradually start strengthening the joint with isometric exercises. This can be done by pressing the foot into the floor or against a wall or chair so that the joint does not actually move but you are activating the muscles. Then introduce exercises that load the joint perhaps using a theraband or similar. Walking is good and when painfree, exercises such as hopping and sprints with a change of direction or side-ways movements will challenge the joint.

Calf strain

This is frequently felt in the lower part of the leg around the Achilles and is usually felt after running for a distance. A strain is when some of the fibres of the tendon have been damaged or torn. Depending on the extent of the damage depends on whether it is a grade 1, 2 or 3 tear. Grade 1 is minor and recovery is within a few days, grade 3 could be a fully torn muscle, such as occurs at the Achilles tendon and may require surgery and long term rehabilitation.

At the onset of calf strain, stop running! Don’t continue as all you will do is increase the extent of the damage. RICE is important but gentle movement (no more than 3/10 in terms of discomfort) during the initial stages will help reduce muscle stiffness and tightening.

Massage can be particularly helpful for muscle strains to encourage scar tissue to form correctly, to reduce trigger points in the affected muscle and associated muscles, and to reduce tension and swelling in the area.

The exercises suggested above for plantar fasciitis are equally important for calf strain as they activate the muscles of the calf. Gentle self-stretching in early stages of rehabilitation should be performed frequently before moving on to a stretching and strengthening program. Static stretches for the calf against a wall help to remind the body to lengthen the muscle fibres and help you realise what is a comfortable stretch so that you know your own range of movement and don’t overdo more active techniques until you are healed. Exercises such as standing on a step, raising up on to tiptoes and gently lowering so that heels are below step level at the end point help both strengthen and eccentrically stretch muscle. Start with both legs working together and when this feels comfortable, then progress on to performing this one leg at a time. Standing on a pillow and doing single legged squats adds some gentle instability into the muscle and joint to stretch while weight bearing. Gradually resume training by starting with a walk and jog routine until you are confident that injury has resolved.

Shin splints

Bones are covered in a protective layer called the periosteum. In shin splints, the muscles around the shin exert too much stress on the periosteum during movement and pull it away from the bone. This can lead to sharp pains, feeling of bumps along the bone, redness and swelling or even a stress fracture of the shin bone, the tibia.

The two key muscles involved are the anterior and posterior tibialis. These muscles are involved in dorsiflexion and plantarflexion of the foot and help the foot to curl medially (inversion). These are all crucial movements in running, which is why any imbalances in these muscles can contribute to shin splints. However, other factors include incorrect footwear, different running surfaces and/or over pronation/supination of the foot.

Immediate treatment is RICE. Gentle movements of the foot to start the initial phase of recovery will help to keep the muscles moving and reduce tightness. However again keep well within your individual comfort levels. No more than a 3/10 in terms of any discomfort. Massage can help to strip the entire musculature and reduce tightness, especially when combined with soft tissue techniques. Direct myofascial release techniques will be of benefit as the intention would be on helping alignment of any scar tissue. Exercises to both strengthen and stretch the calf muscles including using a band to invert and evert the foot whilst it is pointed up and then pointed down will ensure both anterior and posterior muscles are strengthened and stretched.

Taping, orthotics and checking footwear are also measures that can be taken to see if they help the myriad of factors that can contribute to shin splints.

Knee pain

Knee pain is rarely a simple issue! From a therapist perspective, if you have knee pain it is really helpful to know what brings it on: is it distance or going uphill or downhill? Is it anterior, posterior, medial or lateral? For runners, is it lateral knee pain that comes on after running a certain distance? If so it could be ‘runner’s knee’ caused by a tight IT band, is it a wear and tear injury perhaps due to patellar or cartilage problems. Is it due to poor biomechanics, perhaps a rolling of the knee inwards when running?

The movements of the knee are quite limited, so sometimes there are knee problems because of inefficiencies in the musculature that crosses the hips and attaches to the femur (thigh bone). Assessment by a therapist will help provide specific information to help improve the situation. Tight muscles pulling the patellar out of position will benefit from massage so that tension and trigger points can be eased and full range of motion stretches incorporated into your routine. A tight IT band can be helped by massage, myofascial release techniques and stretching. Ligament or meniscus problems can benefit from a strengthening program. Biomechanical issues can resolve with taping, orthotics, appropriate footwear and appropriate massage, stretching and stretching of muscles.

General stretches for improving the knee include quad and hamstring stretches. In severe cases this might start in a seated position and flexing and bending the leg, then adding a weight or using a theraband to add resistance. Once comfortable, standing or using the gym to stretch and eccentrically load the hamstrings and quads can help build up stamina. Incorporating work for the glutes and lateral rotators of the hip will be additional areas to focus on, perhaps if there is a biomechanical imbalance. So activities such as lunges for hip flexors, or using a band around the thighs to activate hip abductors can be beneficial. Stretches should be performed to a 3/10 in terms of discomfort and any strengthening should be varied and kept to just below the onset of symptoms so tolerances can be built up.

Identifying the factors that contribute to knee pain and then providing a treatment program to redress these imbalances takes time and requires commitment from the client to resolve. This is just like any rehabilitation program where you need to reduce muscular tension and develop a new habit to learn correct patterns of movement.

Obviously this is just a brief overview and summary of running injuries but hopefully it provides you with an idea of the scope of work that a clinical massage therapist could help you with. If you would like more bespoke information then please feel free to book in for a session.

Trigger Points

What are they?

Trigger points are highly irritable bands of muscle that are causing referred pain and irritation to the body. The key to trigger points is that they present with a predictable pain pattern. These can be in the immediate area of the trigger point or it can be referred further afield and some examples are shown in the images below.

Headaches occurring in the red zone can be caused by trigger points in the muscle just below the base of the skull. Typically the muscle can get contracted and tight when a computer screen is not at the right height and the user has to tip their eyes slightly upwards.
Many people will not have
heard of a muscle called infraspinatus but they will have heard of ‘rotator cuff’ with respect to injuries. Infraspinatus is one of the rotator cuff muscles. It is the muscle that covers the shoulder blade (as indicated by the ‘x’ marks on the far left diagram). However, look where this muscle can refer pain and discomfort to!

It is amazing to think that irritation of muscle in the shoulder blade could potentially be causing pain down the arm as far as the hand. Usually the irritation for this muscle is on the upper arm and more to the front than the back but to feel it further along the limb is not a surprise, just less common. Frequently one of the causes of trigger points in the infraspinatus is the position of the arm at night when sleeping.

In this diagram a muscle in the neck causes a much more localised pain pattern, with most of the referred pain occurring in the same position as the muscle, in this case the levator scapulae. This is one of the muscles that people feel tension in when they feel their shoulders have moved upwards and are now are stuck just below their ears. Treating this muscle can sometimes feel quite intense so it is always good to let the therapist know if you feel any discomfort during a treatment so that the techniques can be modified to ensure you are comfortable throughout.

How do you treat trigger points?

Well massage is very effective in treating this type of soft tissue problem. Frequently, clients might be having a massage and say something like ‘I felt that in my arm’ when you are working their shoulder for example. So although the client may not have persistent pain, it is present. If the warning signs are ignored, that pain may become a constant nagging ache as the trigger point progresses to a more chronic state. As the muscle with a trigger point becomes contracted and not functioning as smoothly as it should, neighbouring muscles start to be affected as their movement is inhibited. This then leads to the spread of tension and discomfort in the body.

Massage works to manipulate the soft tissues to find any trigger points and then use techniques such as compression, myofascial release and soft tissue release to relieve them. Ideally, you want to be able to improve the blood flow to the area, find the key trigger points and treat them. As muscles are sticky and are used to being stuck in a particular position it can take a few sessions to ensure you have treated them all successfully. However, the end result is that you no longer have those muscles causing pain and restrictions in your body. Perfect!

If you would like to book in for a massage contact Susan Harrison on 0759 050 1552 or email susan@powertouchtherapy.co.uk

Rumour has it… Movement has it all!

So I have corrupted Adele’s lyrics but I wanted to discuss the benefits of movement as not moving can lead to a host of musculoskeletal problems that could potentially also affect mental well-being.

So many aspects of our lives are sedentary: driving, working at a desk, using a laptop or computer, gaming, eating out with friends or even socialising down the pub! If you think about our body position during these activities, although varied, we have hardly moved our muscles or bones!

I see many clients who have problems with their neck, shoulders, hamstrings, quads, calves or buttocks and usually the reason they have come to see me is because the body is not being moved back to centre (neutral) enough. Look at the images below to see what I mean about the body being stuck in the same position all day.

Head forward, shoulders rounded, back curved, bent legs and inactivity throughout. The lack of movement of the body can lead to a host of musculoskeletal imbalances. Fortunately, massage can take away the discomfort associated with poor posture and even recommend exercises to help you redress some of the imbalances in your body.

At Powertouch Therapy (www.powertouchtherapy.co.uk), we are trained in a variety of different stretching and rehabilitation techniques to help improve your posture. So why not book in for a session. Email susan@powertouchtherapy.co.uk or call her on 0759 050 1552 to discuss your particular needs with her. It may take some time before we get you to work with a spring in your step as shown below but we can certainly help you on your journey!

And if you plan to do this, well I would love to be in on that meeting!

Repetitive Strain Injuries (RSI)

Repetitive strain injuries (RSI)

Frequently in massage practice, we see clients who have repetitive strain injuries caused by overuse. Tennis elbow is a typical one but others include golfer’s elbow, biceps tendonitis, superspinatus tendonitis, Achilles tendinopathy, patellar tendonitis and ITB syndrome. These injuries all involve the tendon, which comprises collagen fibres that effectively anchor the muscle to the bone. Clients with these type of tendonopathies experience a burning sensation, sometimes with even light use of the affected joint, lack of strength and limited range of movement. Although these injuries can respond well to treatment especially if treated during the acute stage, frustratingly it can take many months for it to heal once the condition has become chronic (Rattray and Ludwig, 2000). However, for many clients conservative treatment is effective; very few have to resort to steroid injections or surgery.

But what actually is going on?

There have been many investigations to examine tendons that have overuse injuries. What has been identified is that in the vast majority of cases where people referred to tendonitis (‘-itis’ indicates inflammation), surgery and/or pathology of the affected area has only rarely shown signs of inflammation. Indeed the vast majority of the affected tendons exhibit tendinosis (Bass, 2012).

Studies have shown that the collagen fibres in tendinosis injuries are immature, comprise the wrong collagen mix (there are different types of collagen), with increased vascular networks that are of poor quality and have a dull, greyish surface (Heber, 2012). It is thought that the immaturity of the collagen fibres as the muscle is consistently activated is one reason why tendinosis injuries are chronic conditions.

In tendonitis, the collagen fibre mix is ‘normal’ for a tendon, the fibres are aligned neatly, there is a good vascular network and the surface appears shiny and white but there are inflammatory cells are also present . Tendonitis is more commonly associated with a particular activity that has caused the pain and reaction experienced: excessive strain caused by throwing a ball, running, jumping, etc. It can result in microscopic or partial tears of the muscle and in some cases a complete tear of the muscle that requires surgery.

How to treat tendinitis and tendinosis injuries

Bass (2012) suggests that for tendinosis

Rest
Adjusting ergonomics and biomechanics
Use of appropriate support
Apply ice
Stretch and move area conservatively
Eccentric strengthening
Massage
Nutrition

Are all aspects that should be addressed as part of the rehabilitation of the tendon. In fact for tendinitis many of the factors listed above are also relevant, however, the use of anti-inflammatories, ultrasound, physiotherapy, steroid injections or in severe cases surgery may also be required.

Research by Khan (cited in Heber) indicates that for tendinitis injuries when presented at the acute stage recovery time is ‘days to 2 weeks’ yet in the chronic stage is usually ‘4-6 weeks’. Compare this to tendinosis injuries where acute recovery is ‘6-10 weeks’ and for chronic presentation it is 6 to 10 months.

For many tendinopathies, ice and completely resting the affected area for a few days can be the most effective self-care treatment available. Massage, eccentric strengthening of muscles and movement of muscle within pain free range can help with enabling the correct balance and alignment of collagen fibres to develop. Finally, look at the factors that may have contributed to the injury in the first place and see if there are any adjustments (postural, support or techniques) that can be altered to prevent the injury happening again.

References

Bass E. (2012). Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. Int J Ther Massage Bodywork, 5(1): 14–17

Heber M. Tendinosis vs Tendonitis. Web article: www.elitesportstherapy.com/Tendinosis-vs–Tendonitis. Accessed 25^th April 2014.

Rattray F. and Ludwig L. (2000). Clinical Massage Therapy: Understanding and Treating over 70 Conditions. Talus Inc: Ontario, Canada