I’ve been further looking into the problem of what is the optimum exercise protocol for rehabilitating damaged tendons – (i’ve had surgery on both my left and right shoulders recently) and I stumbled upon this paper “Rehabilitation After Tendon Injuries” by Sandra L. Curwin. It’s an excellent paper and I would recommend anyone with similar problems to get hold of it.
Here Curwin states that “The healing tendon must be loaded if collagen synthesis, alignment, and maturation via crosslinking are to be ideal. The more acute or severe the injury (indicated by knowledge of the injury or the degree of symptoms), the lower the force that should be applied. Passive movement produces very little tensile force, is safe immediately after injury, and exerts beneficial mechanical effects on tendon. Gentle stretching would be the next step, followed by increased stretching force and then active exercise”
Curwin then goes on to recommend “The patient should experience pain during the last 10 repetitions of 3 sets of 10 repetitions of the chosen exercise. We determined empirically that the most rapid and consistent improvement occurred if the patient experienced pain between the 20th and 30th repetition of the specific loading movement. Pain before this point (<20 repetitions) was usually accompanied by overall worsening of the patient’s condition, and this indicated overloading. Patients who experienced no pain or discomfort during the 30 repetitions, yet who continued to have symptoms during functional activities, did not see any change in overall status. We suggested that the loading stimulus was inadequate to induce a change in the tendon, and recommended that loading be increased to induce further adaptation.
As the tendon becomes stronger, loading must be progressed so that maximal loads continue to be applied and the tissue will continue to have a stimulus for adaptation. This progress can be made by increasing the speed of movement or by increasing the magnitude of the tensile force through changing the external resistance. The overall progression of loading is determined by the patient’s symptoms, as described above, so that a maximum load is always applied (see Figure 24-11). As soon as 30 repetitions can be performed without discomfort, the tensile force is increased.”
As ever I am going to be the guinea pig in this experiment, so I’ll let you know how I get on.