Last year I attended a conference and was particularly looking forward to listening to a range of experts (many of them surgeons - so they must be clever!) talking about the rehabilitation of tendinopathy injuries.
Whilst I picked up some interesting nuggets of information, one of the overwhelming things I came out of the conference with, was the knowledge that surgeons write lousy rehab programmes!
I sat through several detailed presentations from surgeons that examined the effectiveness of eccentric exercise and was left scratching my head when the only rehab advice that was being churned out focused purely on a unimodal approach (eccentrics). I was particularly perplexed because I had just come back from America where I had presented my approach to returning athletes back to full fitness following chronic tendon related injuries.
One size does not fit all, the law of individual differences tells us this!
What I learnt at that conference was that the best people to ask about rehabilitation from injuries are the guys getting their hands dirty on a daily basis. They'll tell you that in order to rehabilitate an athlete with tendinopathy you will need to take the 'kitchen sink' approach and pull out a range of strategies.
In the past I've used the following strategies and had success:
Movement - Developing a decent 'movement vocabulary' with the athlete so that they move properly.
Functional isometrics - The tendon responds to load and isometrics are a great way to load without 'impact'
Blood Flow Restriction - Another way of loading and developing some cross-sectional area around supporting structures to improve movement quality.
High Intensity Hypoxic Intervals - Use of repeated sprint efforts in hypoxic conditions are a great way to maintain/improve fitness with minimal 'impact' and can provides pain free mechanical stress on the tendon.
GPS - Use of metrics to track mechanical loading in order to guide the rehab process.
If I want to know about surgery I'll speak to a surgeon. If I want to know about injury rehabiltation I speak to the people that are on the floor working with the athlete.