What. A. Year.

None of us have EVER experienced anything quite like 2020.  It has been a year of challenge and change.  We have all been forced out of our comfort zone and had to adapt in ways we never envisioned.  This has not been all bad as it has produced some fantastic innovation and creativity.
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With this in mind, I would like to share some of my thoughts from 2020:
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• People in Saskatchewan rise up in the face of adversity to help each other

In the two days after the snowstorm in November, I can’t even count the number of times I saw not just one, but usually two or three people helping others to push vehicles out of snow and shovel snow. It was wonderful to see.

• Elections are sometimes painful, but necessary

Three elections in less than a month was a dream come true for media outlets.  There was a lot of controversy, much debate, and some down-right nastiness.  However, we are blessed to live in a place where we have the democratic right to choose our government representatives.  We sometimes take this for granted and we should not.

• Heroes are among us

Hollywood and the comic industry have produced an abundance of superheroes that entertain us and feed our fantasy.  This year has shown us that there are real-life heroes living with us.  Front line health care workers, researchers, government leaders (yes, some politicians are heroes), celebrities, and others.  There have been many examples in 2020 of individuals from these groups rising up and contributing massively to our society. 

“Good leaders don’t make excuses. 
Instead, they figure out a way to get things done.”
 Jocko Willink
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Well, here we are again... “the most wonderful time of the year!”, and what a year it has been!

I wrote the Christmas Blog last year as well and got to learn a little about my coworkers Christmas traditions. So this year, join in for some more fun and get your Dean Martin singing voice out.... here is a little Donald Physiotherapy parody for all.

Need inspiration for the tune - check out Walking In A Winter Wonderland by Dean Martin on YouTube.
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WALKING INTO DONALD PHYSIO
 
Back ache pains, we can help you
Got a sprain, we assess you
Our staff’s a delight, we’ll treat you right
Walking into Donald Physio
 
Gone away are your issues
You don’t need no more tissues
You’re feeling good, you move like you should
Walking out of Donald Physio
 
In the clinic we can build some muscles
And educate you on some simple points
We’ll say “are you ready”, but let’s not hustle
 Cause you can use the time for all your joints
 
Later on, we’ll conspire
As you plan to reach higher
To face unafraid, the plans that you’ve made
Walking into Donald Physio
 
Back ache pains, we can help you
Got a sprain, we assess you
Our staff’s a delight, we’ll treat you right
Walking into Donald Physio
 
 
From all of us at Donald Physiotherapy, we hope your Christmas is filled with love, laughter, new traditions and old!
 
Merry Christmas & Happy New Year
 
Jacquie

It’s been over a year since I last wrote about tendons, so it’s time for an update! Tendon injuries are a very common condition that can affect your work, sport, and daily life on a regular basis. The original post on the topic can be found here.
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Tendon Structure:

The tendon is the portion of the muscle that attaches directly to the bone. It is less elastic than the muscle tissue and has significantly less blood flow as well.

In a healthy tendon, the fibers are aligned well and have a good mix of collagen that allows it to fulfill its function.

In an injured tendon, this alignment becomes more disorganized and tiny blood vessels try to penetrate into the tendon to provide nutrients and blood flow for the repair/healing process. (These small blood vessels are thought to be quite sensitive and a possible explanation for some of the chronic pain that comes from tendon injuries). 

Tendon Regulation:

Normally, the tendon and most of the tissues in our body are going through a regular amount of both breakdown and repair (think like the top layers of our skin that are replaced by fresh skin on a regular basis).

When a tendon is unable to keep up with the regular breakdown of our tissues, it can lead to tendon injury. There are number of risk factors that are considered, such as:

• Advanced age
• Cholesterol
• Diabetes
• Overuse

 
But you also need to consider the internal factors as well. This includes:

• a lack of oxygen and nutrients and
• the ongoing presence of inflammation,

Both of which adds stress to the system.
 
One theory is that while your body is trying to keep everything equal, these factors can push our tendons towards a tipping point -  the rate of breakdown is greater than the rate of repair.

The tipping point is where you see a decrease in the function of the tendon.

This tipping point helps to explain how your rotator cuff or hip pain can develop gradually or spontaneously without doing anything different or special in your day.

The tendon did the best it could, until it couldn’t cope any further. And that’s when you first recognize the symptoms. 

nce the tendon is in this predicament, what do you do?
 
Exercise.
Love it or hate it, this is one of the first-line interventions that can provide changes to the tendon with almost no downside. What you may be happy to know is that there is no exact type of exercise that is better than the rest.

The most important factors appear to be

• keeping up with exercise long enough for tissues to change/grow and
• do something that is challenging enough to make the body work hard enough.

When compared to various surgeries and injection of medications, exercise does just as well in the long term. Exercise can be painful to perform at first, but this is not associated with any long term downsides that we know of.
 
Nutrition
Another powerful, but difficult to change part of your life. Avoiding diabetes and high cholesterol complications can be very important for tissue health. If this is well managed, it should be something that can be worked around.

Supplements are hard to recommend specifically.  But you may hear of such things as

• Vitamin C
• Vitamin D
• Leucine
• Glucosamine and Chondroitin sulfate

 
According to research it is too soon to tell in a complex environment if these will have the desired effect.
 
Drugs/Passive Interventions
Because the deepest parts of the tendon do not have much blood flow, taking medication by mouth seems to have a poor effect overall.

Injection treatments are encouraging, but require more study before they could be recommended for all cases.

Modalities like ultrasound, low level laser therapy (LLLT), and various other devices seem to be able to provide short term relief for some people, but more research is required to know how they best fit into the picture on a more general level.

It seems likely that this type of treatment needs to be used in combination with other aspects of care to get the best result.
 
We have just scratched the surface regarding active care of tendons.

There will be a following post in the future that goes deeper into the exercise models that currently exist for tendon rehabilitation.

If you have any questions or comments about today’s post please feel free to contact the office directly.