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Dr. Ebonie Rio on The Fundamentals of Tendon Training and Rehabilitation: Just Fly Performance Podcast #144

Today’s episode features Dr. Ebonie Rio, leading researcher in tendon pain and rehabilitation at La Trobe University.

Ebonie has a clinical career that has taken her to the Australian Institute of Sport, the Australian Ballet Company, Australian Ballet School, Melbourne Heart Football Club, Alphington Sports Medicine Centre, 2010 Vancouver Winter Olympics and much more.

In approaching the full spectrum of training, the field of tendons and connective tissue represent an area that not much is known relative to others, such as muscle physiology.  Even our fascial system has been referred to as a “dark matter” of sorts since there is a lot about it we do not know.

This manifests itself into tendon injuries (think knee/patella and Achilles) being very nagging and hard to rehabilitate because they do not “play by the same rules” as muscles and bones.  At the same time, when we train for performance and injury prevention, knowing how to improve the capacity of our myo-fascial system to sustain and handle loads is critical.  It is also important to look at how various training means will have an impact on not only our muscles, but how our tendons and connective tissue adapt.

This episode with Ebonie Rio is fantastic for helping to build a more well-rounded knowledge of athletic tissues and subsequent training.  In this episode, Ebonie covers why tendons are different than muscle, how to optimally load them in training and rehab, as well as brain science and tendon training.  

Today’s episode is brought to you by SimpliFaster, supplier of high-end athletic development tools, such as the Freelap timing system, kBox, Sprint 1080, and more.   

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Key Points

  • Why tendon injuries are fundamentally different than injuries of other tissues in the body
  • Optimal contraction and tempo emphasis for the sake of tendon training and rehabilitation
  • The four types of loading on tendons
  • How the “24 hour rule” provides guidelines for the art of tendon loading in rehabilitation
  • How strong muscles can help mitigate tendon injuries
  • Guidelines for range of motion when rehabilitating tendons
  • Improvement in neuromuscular versus physical changes in the rehabilitation of tendons
  • How to approach prevention of tendonous issues in sport performance
  • How tempo oriented and metronome training is great for both the brain and tendon rehabilitation
  • Ideas on maximizing tendon strength for athlete performance

“Our tendon injuries provided us the biggest challenge (compared to broken bones or muscle strains)”

“Tendons don’t have an inflammatory process, muscles have a 3-phase response of inflammation…. Tendons are not the same, the pain is not inflammatory”

“If we say things like tendonitis (incorrectly), that really invokes an inflammatory condition, and that means people will think of a passive approach.  We use the word tendinopathy which gives the indication for a load based program”

“Tendons really love load, we just have to help them with the timing and the progression of it”

“When you rest, you drop (tendon loading) capacity”

“There is no one recipe that people should do that completely rehabilitates a person.  It has to incorporate (all training tempos) and it needs to be progressive.”

“The first type of loading on a tendon is a tensile load; it is when I ask your tendon to store and release energy like a spring”

“The next load is compression, compression is where the tendon is sort of squashed against a bone, like our Achilles tendon when in dorsiflexion”

“The third load is a combined load of tensile load and compression… like a fast change of direction where you drop into dorsiflexion and then switch the other way”

“Our final load is a shear or friction load”

“Anything that is fast and in compression is provocative for a tendon”

“Isometric strategy is the first way in; it won’t provoke tendon pain since it’s not fast”

“One of the things we teach our coaches and physios is when to listen to your tendon, when to listen to the tendon is 24 hours after the load you’ve put on it”

“If after 24 hours, your pain/stiffness has gotten worse, then your tendon is not happy with what you did the day before”

“We teach people to listen to their tendon (mostly in the warmup or before the warmup, not so much during the workout since tendons warm up to work out)”

“In double leg exercises the tendon can find a place to hide”

“You can get much greater load on the muscle in dorsiflexion than plantar flexion or neutral”

“Compression is so provocative that we talk to people about not being in bare feet (in cases of Achilles tendonitis)

“In the first 4 weeks of a (tendinopathy) program, they changes we see are neurological; studies that have looked at a tendon over a week, 4 weeks or 12 weeks don’t show (any tendon change)”

“I think everything changes (in tendinopathy rehabilitation).  Bioplastic accounts for the fact that every single cell in our body is capable of change until the day we die.  

“What changes when we do a load program; I would argue everything… we are changing muscle and tendon, even if our techniques aren’t good enough to pick it up.  The contribution of each of those to the change depend on the time point on which you measure it.”

“(For the sake of tendon training and injury prevention) Keep your athletes strong, we love single leg work, we love isolated work”

“In people with tendon pain, they have a disruption between their brake and their accelerator, and what the external pacing does is retrain their brain’s control of their muscle”

“Plyometrics didn’t have the effect that we thought on tendon strength (compared to heavy lifting according to a recent research review)”

Show Notes

Bohm’s systematic review on loading means and Achilles tendon strength and development

About Dr. Ebonie Rio

Ebonie is a post doc researcher at La Trobe University and has completed her PhD in tendon pain, Masters Sports Phys, B. Phys (Hons) and B. App Sci.

Her clinical career has included Australian Institute of Sport, Australian Ballet Company, Australian Ballet School, Melbourne Heart Football Club, Alphington Sports Medicine Centre, Victorian Institute of Sport, 2006 Commonwealth Games, 2010 Vancouver Winter Olympics, 2010 Singapore Youth Olympics, 2012 London Paralympics, 18 months travelling with Disney’s The Lion King stage show (Melbourne and Shanghai tour).

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