128 - Tendon Pain Update (with Jill Cook)

Whitney interviews tendon expert Dr. Jill Cook, who discusses the current understanding of tendinopathy as a degenerative condition, emphasizing the importance of proper loading in rehabilitation. She explains why she advises against traditional treatments like friction massage and stretching, why anti-inflammatory medications are ineffective, and highlights the risks of certain drugs on tendon health. Throughout the conversation, Dr. Cook provides evidence-based insights for all manual therapists on treating tendinopathies effectively.
Key Topics:
Shift from thinking of tendinopathies as inflammatory conditions to degenerative conditions (03:01 - 04:24)
Factors that contribute to pain in tendinopathies (04:40 - 05:41)
Clinical signs and symptoms of tendinopathy (06:06 - 08:34)
The role of loading and compression in tendon pathology (08:54 - 16:45)
Treatment strategies for tendinopathies, including friction massage and anti-inflammatory medications (19:06 - 31:48)
Medically-induced tendinopathies, such as those caused by antibiotics (32:05 - 35:04)
The role of active movement and soft tissue treatments in tendinopathy rehabilitation (35:30 - 38:29)
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Resources mentioned in this episode:
Jill Cook: [e-mail]
Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat. 2006;208(3):309-316. doi:JOA531 [pii] 10.1111/j.1469-7580.2006.00531.x
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(The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)

[@spiralphysiotherapy4196]

Degenerative but not painful > probably bc these cohorts aren't profoundly active (oldies that waddle around not much else). Active cohorts (play sport) with reactive and degenerative changes will have pain from experience. I think the pain is driven by the structural changes including angiogenesis develivering more blood and PG and Glycosaminoglycans causing osmosis to the area newly infiltration by nerves being innervated > pain. There may also be something to do w/ degeneration of extracellular matrix gel not allowing smooth gliding b/w fascicles etc

[@spiralphysiotherapy4196]

Disagree w/ the point at ~11min. Ligaments and Tendons adapt and get stronger w/ load regardless of age. Case in point Michael Johnson ran a 10.09s 100m in 94' (age 27) , a 19.32s 200m in 96' (age 29) and, a 43.18s 400m in 96' (age 32). Given sprinting success is multi-variable, these feats wouldn't be possible if tendons stopped adapting/growing/remodelling etc after adolescence (just seems non-sensical).

[@spiralphysiotherapy4196]

If one looked a at degenerative tendon image and the client was a very poor mover and inattentive (but asymptomatic) I reckon you could money on that person incurring a rupture at some point