Vitamin C-Enriched Gelatin for Tendon Health

Nutritional and/or exercise interventions that increase collagen synthesis and strengthen these tissues could have an important effect on tendon injury rates.

This RCT investigated whether consuming gelatin (a food derivative of collagen) and vitamin C combined with exercise could increase collagen synthesis.

KEY FINDINGS:
Participants drank vitamin C–enriched gelatin or placebo.
Blood was taken every 30 min.

1 hour after the initial supplement, 6 min of rope-skipping.
Repeated 3x/day with 6 h between exercise for 3 days.

Increasing amounts of gelatin increased circulating:
Glycine, proline, hydroxyproline, and hydroxylysine.
Peaking 1 h after the supplement was given.

Engineered ligaments treated for 6 days showed increased collagen content and improved mechanics.

Subjects who took 15 g gelatin 1 hour before exercise showed 2x amino-terminal propeptide of collagen I in their blood, indicating increased collagen synthesis.

MAIN TAKEAWAYS:
Supplementation with gelatin in humans augments collagen synthesis after exercise.

The accelerated rate of collagen synthesis was observed as early as 4 hours after the first bout of exercise.

This was maintained over the 72 h of the study.

Adding gelatin and vitamin C to an intermittent exercise program could play a beneficial role in injury prevention and tissue repair.

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SOURCE:
Shaw et al. 2017. Am J Clin Nutr 2017;105:136–43

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics. 

Want to learn more or contact him?

Reach out online:

@physicaltherapyresearch

@Grapplersperformance

www.grapplersperformance.com

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Improving Tendon Health

Recently, engineered ligaments have been developed using cells from human ACL or hamstring tendons. This research used this technology to learn how to best improve performance, prevent injury, and accelerate return to play in injured tendon/ligaments.

KEY FINDINGS:

Loading Effects:

• Tendons, like other forms of fibrous connective tissue such as bone and ligaments, adapt to their loading state.
• Molecular adaptation to loading was independent of the frequency and intensity.
• Time however DID alter the cellular response; Within 10 min of starting the activity, the molecular response peaks.

Hormonal Effects:

• 48 h of high estrogen level was enough to decrease the stiffness of ligaments without change in collagen content.
• Exercise produces global hormonal signals, which improves connective tissue function.

Nutrition Effects:

• Amino acids enriched in collagen & added together with vitamin C can improve collagen synthesis.

MAIN TAKEAWAYS:

Connective tissue can be trained:

• 10 min of activity, targeted to a tendon/ligament.
• Exercises performed with a light weight either 6 h before or after any other training.

Following Injury:

• Begin training as soon as possible.
• Simple range-of-motion and light exercises (amplitude of the load is not important for stimulating collagen production).
• Ideally performed 3x/day. Ex. Jump-rope for Achilles Tendon.

Best Nutritional Support:

• Consume leucine-rich protein as part of training to benefit from added muscle mass, strength and mTORC1 activation.
• Glucose uptake into tendons increases during exercise.
• 30-60min before training, consume 15 g of gelatin.

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SOURCE:
Injury & Performance Lessons from Engineered Ligaments. Barr 2017. Sports Med (2017) 47 (Suppl 1):S5–S11.

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics. 

Want to learn more or contact him?

Reach out online:

@physicaltherapyresearch

@Grapplersperformance

www.grapplersperformance.com

Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

Learn more online - new online discussion group included!

Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. 

• NEW - Online Discussion Group
• Live cases
• webinars
• lecture
• Live Q&A
• over 600 videos - hundreds of techniques and more! 
• Check out MMT Insiders

Keeping it Eclectic...

💎Lower Body Tendon Health: 6 Bodyweight Exercises⤵️

Via Matt Ibrahim on instagram- 5 + 1 Bonus Bodyweight Lower Body Tendon Exercises
👌🏼Right now serves as a great time to work on your lower body tendon health.

Hi All,

On this talking tendons episode, I dive into the very murky world of isometric exercise and their effect on tendon pain. A new study by Sinead Holden and team brings some (just a little) light to the evidence. I argue that isometrics are useful for managing tendinopathy, but using them for short term pain reduction is just the tip of the iceberg.

Also if you're wanting to earn some extra CPD before Christmas check out my two upcoming workshops in December in Sydney and Melbourne (bookings).

Via - Peter Malliaras - Tendonopathy Rehab

Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

Learn more online!

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Tendons and tendinopathies are hot topics and still widely misunderstood by both patients and providers. Here are 5 frequently asked tendon questions and answers from Dr. Peter Malliaras of Tendinopathy Rehab. Infographic by Brad Beer.

View this post on Instagram

[5️⃣TENDINOPATHY FAQs ]❓ _ ☝🏻these are 5 FAQs I am often asked by clients who are rehabilitating tendons 👀 _ 👉🏻 I threw them to @tendinopathyrehab (Specialist Tendinopathy Physio & Assoc Professor 👨‍🏫) recently on a @physicalperformanceshow Expert Edition 1️⃣6️⃣1️⃣. Below is a brief summary with quotes from @tendinopathyrehab: _ 1️⃣ Is cortisone bad? ‘We don’t know, the jury is still out. It can be bad if have a lot of it (opinion)’ 💉 . 2️⃣ Why does it warm up (24hrs later)? ‘Tendon pain & symptoms will manifest , you often will find it gets better with activity-the next day is when you flare if what you have done has been too much the prior day’ 🕐 . 3️⃣ Can’t I just I get shockwave therapy to fix it? ‘No-shockwave will help for some people (approx. half) with pain, most people just get short term relief, by and large what we know from the evidence & clinical experience is that it is not going to be the ‘fixer’ for most people’ ➡️ . 4️⃣ Is this bump on my tendon bad? ‘Not necessarily. The bump is there to stay, it doesn’t necessarily get better. If you have a bump but nil pain, there is potential to go on and rupture the achilles tendon -good progressive rehab program will hopefully mitigate the risk of rupture’ ⬇️ . 5️⃣ Am I at risk of rupturing the tendon if the achilles is sore? ‘No. From the evidence the risk is very very small. The risk for people with tendon pain of rupturing is less than 1% overall’ 🧐 _ ‼️If you know a runner or someone this can help please tag them in ✋🏻 _ ❓Q’s and comments are welcome _ 📌To learn more about tendon rehabilitation tune into Expert Edition of @physicalperformanceshow feat. @tendinopathyrehab available wherever you get your podcasts @itunes @spotify @soundcloud @stitcherpodcasts or jump over to bio link-I hope you benefit from the learnings ✅ . . . #tendon #rehabilitation #podcast #physiotherapy #physio #sportsphysio #running #tendrehab #sportsphysio #tendontuesday @pogophysio

A post shared by Brad_Beer Running.Physio 🏃‍♂️ (@brad_beer) on May 28, 2019 at 12:51am PDT

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This post was first found on Tendinopathy Rehab blog

Prior to launching into this podcast, I just wanted to announce I am coming to the UK for a course series. Selling really quick but some seated remaining.

Check out remaining dates HERE.

 

Isometric exercise for tendinopathy has exploded onto the scene over the last few years. Unfortunately, the certainty of evidence surrounding their use is far less certain and compelling than what we are told about them but some people. They may work, but the reality is we don't fully understand how and for whom. This episode delves into this uncertainty and provides lots of top tips for how to use isometrics and when they are useful.

Enjoy!

Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

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Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

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Many runners and other active individuals develop Gluteal Tendinopathy. It can be mistaken for a sensitized lumbar spine or other hip dysfunction. Here's another great infographic from Brad Beer - Running.Physio for 5 Things to Do with Gluteal Tendinopathy

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[5️⃣ GLUTEAL TENDINOPATHY TIPS] 💡 _ ☝🏻Here are some tips for managing your gluteal tendinopathy 🍑: _ 1️⃣ Seek help: the first key in moving forwards with rehabilitation is to seek early help rather than ‘putting up with pain’ for months (sometimes years on end). The longer the duration of symptoms typically the longer the rehabilitation time ⏱ . 2️⃣ Deload: it is important to get pain and symptoms reduced (reducing irritability of the tendon) as soon as possible. Reducing loading may be achieved by reducing running volume (or intensity or both), and other activities such as cross legged sitting, prolonged ‘lazy standing’ etc ⬇️⚖️🍑 . 3️⃣ Isometric glute medius exercises: can have a pain reducing effect on the tendon. Literature suggests 5x30-45s holds, which when trying to reduce symptoms can be done multiple times per day (for example side leg lifts without resistance progressing to resisted leg lifts) ⤵️ . 4️⃣ Commence isotonic loading: Build gluteal tendon strength/capacity: I like to see runners being able to progress to loads through rehabilitation such as being able to do standing cable abductions: target 10-20kgs with for example 4x6reps with good control 🏋️‍♂️ . 5️⃣ Monitoring the tendon’s response to loading and knowing when to do more or do less is key throughout rehabilitation. While guidelines such as staying within what is ‘acceptable pain levels’ can work for some people I find that the bulk of people do better with a numeric guide such as 5/10 pain may suggest the tendon has ‘done too much work’. This is best assessed 24hr after exercise or loading⏰ _ 📌TAKE HOME: These 5 tips are just a few of the numerous considerations that need to be given in order to rehabilitate gluteal tendinopathy. Remain patient and consistent and keep going ✅👟 _ ‼️If you know a runner this can help please tag them in ✋🏻 _ ❓Q’s and comments are welcome . . . #physio #physicaltherapy #run #running #runner #rehabilitation #run #runner #running #sportsscience #marathon #marathontraining #strength #triathlon #ultrarunning #trailrunning #trackandfield #tendontuesday

A post shared by Brad_Beer Running.Physio 🏃‍♂️ (@brad_beer) on May 16, 2019 at 2:53am PDT

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Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...

Current research for tendinopathies and the trend for loading over passive care like modalities and manual therapy is great. Those of us originally trained in manual therapy often don't get to loading fast enough, or at all in some cases if the patient is pain free. What would you do in this recent case of elbow tendinopathy Erson recounts?

Search for Untold Physio Stories on your favorite music/podcast apps!

Untold Physio Stories is sponsored by the EDGE Mobility System, featuring the EDGE Mobility Tool for IASTM, EDGE Mobility Bands, webinars, ebooks, Pain Science Education products and more! Check it out at edgemobilitysystem.com .  Be sure to also connect with Dr. Erson Religioso at Modern Manual Therapy and Andrew Rothschild at Modern Patient Education.

Keeping it Eclectic...

via Tendinopathy Rehab

Injections such as steroid and platelet-rich plasma continue to be popular for tendinopathy, and there are other emerging injections such as the high-volume injection. Take a listen to the latest episode of 'Talking Tendons' where I discuss the latest evidence.

If you're interested in delving deeper into the conversation I will be hosting a 1 day seminar in Melbourne on the 4th May 2019 titled Injection Therapy in Tendinopathy: Art & Science.

We are lucky to be joined by both international and national speakers including Dr Brooke Coombes (Physiotherapist), Dr John Orchard (Sports Physician), Dr Glen Whittacker (Podiatrist), Dr Dean Samaras (Podiatric Surgeon), Prof Dylan Morrissey (Physiotherapist), Dr Otto Chan (Radiologist), Dr Hans Tol (Sports Physician), A/Prof Jane Fitzpatrick (Sports Physician) and A/Prof David Connell (Radiologist).

 BOOKINGS

References

1. Boesen, Anders Ploug, Hansen, Rudi, Boesen, Morten Ilum, Malliaras, Peter, Langberg, Henning. Effect of High-Volume Injection, Platelet- Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy. The American Journal of Sports Medicine. 2017;45(9):2034-43.

Peter Malliaras
Tendinopathy Rehabilitation

Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

Learn more online!

Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...

The Talking Tendons podcast was first found on tendinopathyrehab.com

In this week's podcast, I delve into the minefield that is isometric exercise. Is it the best thing since sliced bread? Does everyone respond? What are the key questions we need to understand?

 On another note, I am excited to announce the UPDATE of my Mastering Lower Limb Tendinopathy course. It will be launched this December and will include all the new evidence out and lots of new clinical info! 

 Hope you enjoy!

Peter

More Podcasts

1. Efficacy of PRP injections for tendinopathy…really?

2. Non-uniform Achilles tendon strain: What is it and should we care?

3. Technology focused systematic reviews that will change your practice

4. Finally some quality exercise research for the management of gluteal tendinopathy

5. What’s the deal with gluteal strength and patellar tendinopathy: big fish, small fish, or not even in the sea?

6. Does your psychological wellbeing affect your tendinopathy treatment outcome?

Keeping it Eclectic...

Eccentric heel drops are a great and evidenced way to treat achilles tendinopathy. However, many times, there is a mobility issue in ankle dorsiflexion, lateral tibial glide and/or tibial internal rotation.

Photo by Ehimetalor Unuabona on Unsplash

In the latest episode of 'Talking Tendons' we consider the latest research exploring psychological factors and tendinopathy. 

There is emerging evidence that, as per other musculoskeletal conditions and as you would expect, they play a role. I discuss which ones appear to be most strongly linked.

On another note, if you are in or around Melbourne I am holding my 1.5 day face to face course on Mastering Lower Limb Tendinopathy at the end of November. All details can be found here.

 I hope you enjoy.

via Dr. Peter Malliaras - Tendinopathy Rehab

More Podcasts

1. Efficacy of PRP injections for tendinopathy…really?

2. Non-uniform Achilles tendon strain: What is it and should we care?

3. Technology focused systematic reviews that will change your practice

4. Finally some quality exercise research for the management of gluteal tendinopathy

5. What’s the deal with gluteal strength and patellar tendinopathy: big fish, small fish, or not even in the sea?

Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

Learn more online!

Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...