Body Mechanics – nourish your tendons and ligaments to keep your body on the move.

Tending to your tendons and ligaments may not be at the top of your “selfcare” priority list. But these structural connective tissues are necessary to keep our bodies moving efficiently—they enable us to sit, stand, walk, and perform virtually all physical activity. Weak or injured tendons and ligaments can be disabling and may lead to chronic pain, making it important to nourish them before problems arise. This becomes especially important as we age.

Tendons and ligaments are strong, flexible connective tissues that are an essential part of the musculoskeletal system. While they are related in collagen_proteincomposition—mostly collagen, with small amounts of elastin and other proteins—and ultimately work as a team, they have different functions in the body. Tendons connect muscle to bone, allowing muscle contractions to move your skeleton, while ligaments connect bone to bone, forming and stabilizing joints and keeping your skeleton intact. The Achilles tendon is one of the more commonly known tendons and the ACL (anterior cruciate ligament) is a well-known (and commonly injured) ligament.

Tendon and ligament injuries are common in athletes and active people, in older adults, and in those who regularly perform activities that require repetitive movement, including work-related activity. Tendons are especially prone to injuries due to overuse, resulting in inflammation and weakening of the tendons. Heard of tennis elbow? That’s actually a case of tendonitis, which is inflammation and irritation of a tendon in the elbow, and rarely is it actually caused by playing tennis.

Collagen, the major component of these connective tissues, begins to degenerate and stiffen as we age. Additionally, tendons and ligaments have a poor blood supply, making existing injuries harder to heal, leading to decreased strength in those tissues and chronic pain.[i] Because the integrity of these connective tissues decline with age, leading to weakened tendons and ligaments and potentially an injury and/or chronic pain, it is important to support them with good nutrition and a few choice supplements.

Collagen. Collagen is the main structural protein that makes up all human connective tissue, including tendons and ligaments, and helps keep these tissues strong. As we age, collagen production slows and existing collagen can deteriorate, causing tendons and ligaments to weaken. A diet high in quality protein will provide the building blocks the body requires to make collagen, including the amino acids proline and lysine.[ii] Additionally, collagen supplements have been shown to stimulate collagen production, helping to maintain healthy tendons and ligaments.[iii]

Dark green vegetables are also excellent examples of food containing collagen producing agents.  Add drak green leafy veggies such as spinach, cabbage and kale to your diet every day.  They are packed with an antioxidant called lutein.  You need 10 mg to get results – which equates to about  4oz. of spinach or 2oz. of kale.  Also Soy products such as soymik and cheese contain an element known as genistein. The presence of genistein gives soy products their collagen production qualities, as well as helping to block enzymes that tend to break down collagen.  Just about any soy product contains enough genistein to be helpful, including soy products that have been developed as substitutes for meat products.

Oestrogen, derived from plants, is vital to making healthy collagen.  Lots of  foods contain plant ­oestrogens (phytoestrogens) that can help replace the effects of lost oestrogen. Try hummus, nuts, soy and pinto beans.

Lycopenesl  Red fruits and vegetables also are excellent sources to up the collagen content of foods in the diet.  The presence of lycopenesl in these types of foods helps to act as antioxidants, which in turn increases collagen production. Try adding red peppers, beets, and fresh or stewed tomatoes to the diet. Also include sweet potatoes, carrots and more.

Vitamin C. Vitamin C is required to convert the amino acids proline and lysine into collagen[iv]; in fact, vitamin C plays such an essential role in collagen production that a deficiency can weaken the tendons and ligaments.[v] The vitamin also reduces inflammation due to injury or overuse. In a human cell model of tendonitis, a proprietary combination of collagen and vitamin C suppressed a number of pro-inflammatory compounds and promoted healing.[vi] Good sources are green pepper (higher vit C content when cooked), dark green leafy veg like broccoli and sprouts, guava, papaya, kiwi fruit and oranges.

Anthocyanidins. The anthocyanidins found in dark-colored fruits such as cherries and blueberries, and in grape seed extract and Pycnogenol®supplements, have been shown to help the collagen fibers link together in a way that strengthens the connective tissue matrix.[vii]

Hyaluronic Acid. Hyaluronic acid is a component of tendons and ligaments and has been shown to stimulate collagen production.[viii] It is also comprises the synovial fluid that surrounds certain tendons, helping to keep them lubricated and moving smoothly.[ix] Researchers recently discovered that a thin layer of “skin” made of epithelial cells covers the tendons;[x] because hyaluronic acid is a major component of connective and epithelial tissues, it is thought to help maintain the integrity of this tendon “skin.” An animal model of tendon injury found that hyaluronic acid significantly speeded healing.[xi]  Hyaluronic acid or hyaluronate is available in capsules or injectables and found in glucosamine supplements.  Beans help your body produce hyaluronic acid.  Aim for at least two tablespoons of beans each day – broad or butter beans make a great substitute for mashed potatoes.

Gelatin. Gelatin-rich foods have long been a part of traditional diets—cultures around the world commonly consume all parts of animals, including the gelatin-rich cartilage and bones. Consuming gelatin has been shown to increase collagen proteins in the blood,[xii] helping to build the structure of both tendons and ligaments. One easy way to introduce more gelatin into your diet is to regularly make and consume bone broth, a savory broth made by simmering bones in water. (Ever made homemade chicken broth from a chicken carcass? That’s one type of bone broth.) Or consider taking a gelatin supplement.

Although caring for your tendons and ligaments may not occur to you until you are already suffering from pain or an injury, maintaining the health of these important connective tissues may just save you from an injury in the first place. A healthy natural foods diet along with a few choice supplements will help nourish these connective tissues, keeping them healthy and strong, and keep you moving smoothly through life.

Article adapted from: Lidsy Wilson, Healthy Hotline, naturalgrocers.com; Kim Jones, 9 ways to keep collagen healthy, The Mirror.CO.UK; Verdungal, How to increase collagen from eating the right foods, Heathcentral.com.

References
[i] http://www.sandiegohealthclinic.com/services/prolotherapy.html

[ii] http://www.whfoods.com/genpage.php?tname=fightdz&dbid=6

[iii] Wilson, L. “Structural Integrity: Collagen for joint and skin health” Health Hotline, Feb 2012

[iv] http://www.whfoods.com/genpage.php?tname=fightdz&dbid=6

[v] http://www.nutritionreview.org/library/collagen.connection.php

[vi] Shakibaei M, Buhrmann C, Mobasheri A. “Anti-inflammatory and anti-catabolic effects of Tendoactive® on human tenocytes in vitro.” Histoland Histopathol 26, 1173-1185, 2011.

[vii] http://www.ncbi.nlm.nih.gov/pubmed/12635161

[viii] Bruce A. Mast, Robert F. Diegelmann, et al. “Hyaluronic Acid Modulates Proliferation, Collagen and Protein Synthesis of Cultured Fetal Fibroblasts.” Matrix Vol. 13/1993, pp. 441-446

[ix]http://www.wellnessresources.com/health/articles/hyaluronic_acid_for_ten…

[x] Susan H. Taylor, Sarah Al-Youha, Tom Van Agtmael, et al. “Tendon Is Covered by a Basement Membrane Epithelium That Is Required for Cell Retention and the Prevention of Adhesion Formation.” PLoS ONE;  2011 January

[xi] Thijs de Wit, Dennis de Putter, Wendy M. Tra, et al. “Auto-crosslinked hyaluronic acid gel accelerates healing of rabbit flexor tendons in vivo.” J Orthop Res 27:408–415, 2009

[xii] Koji I, Takanori H, et al. “Identification of Food-Derived Collagen Peptides in Human Blood after Oral Ingestion of Gelatin Hydrolysates.” J Agric and Food Chem, 2005, 53 (16), pp 6531-6536

 

 

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Achilles Tendon Rupture – Diagnosis, Treatment and Pilate’s for Rehabilitation

The Achilles tendon is the confluence of the independent tendons of the gastrocnemius and soleus, which fuse to achilles_backandsideviewbecome the Achilles tendon
approximately 5 to 6 cm proximal to its insertion on the posterior surface of the calcaneus.
The gastrocnemius and soleus muscles, via the Achilles tendon, function as the chief plantarflexors of the ankle joint. This musculotendinous unit provides the primary propulsive force for walking, running, and jumping. The normal Achilles tendon can withstand repetitive loads near its ultimate tensile strength, which approach 6 to 8 times body weight [1].

Complete Achilles tendon ruptures occur most commonly at the mid-substance, but also distally at the insertion site or proximally at the myotendinous junction. These can be traumatic and devastating injuries, resulting in significant pain, disability, and healthcare cost. As many as 2.5 million individuals sustain Achilles tendon ruptures each year and the incidence is rising [2]. This trend is due, in part, to an increase in athletic participation across individuals of all ages.

Achilles tendon rupture is when the achilles tendon breaks. The achilles is the most commonly injured tendon. achilles_tendon_ruptureRupture can occur while performing actions requiring explosive acceleration, such as pushing off or jumping. For a 150 lb person the amount of muscle force that would have to be generated to rupture the Achilles (excluding external trauma forces) would be 900 – 1200 lbs. The male to female ratio for Achilles tendon rupture varies between 7:1 and 4:1 across various studies.

The Achilles tendon is most commonly injured by sudden plantarflexion or dorsiflexion of the ankle, or by forced  dorsiflexion of the ankle outside its normal range of motion. Other mechanisms by which the Achilles can be torn involve sudden direct trauma to the tendon.  Some other common tears can occur from overuse while participating in intense sports. Twisting or jerking motions can also contribute to injury.

Most cases of Achilles tendon rupture are traumatic sports injuries. The average age of patients is 29–49 years with a male-to-female ratio of nearly 20:1.

Diagnosis is made by clinical history; typically people say it feels like being kicked or shot behind the ankle. Upon examination a gap may be felt just above the heel unless swelling has filled the gap. Walking will usually be severely impaired, as the patient will be unable to step off the ground using the injured leg. The patient will also be unable to stand up on the toes of that leg, and pointing the foot downward (plantarflexion) will be impaired. Pain may be severe, and swelling is common.  Sometimes an ultrasound scan may be required to clarify or confirm the diagnosis. MRI can also be used to confirm the diagnosis.

Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. Among the medical profession opinions are divided what is to be preferred.

Non-surgical management traditionally consisted of restriction in a plaster cast for six to eight weeks with the foot pointed downwards (to oppose the ends of the ruptured tendon). But recent studies have produced superior results with much more rapid rehabilitation in fixed or hinged boots. Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option was long thought to offer a significantly smaller risk of re-rupture compared to traditional non-operative management (5% vs 15%).[3]

Non-surgical treatment used to involve very long periods in a series of casts, and took longer to complete than surgical treatment. But both surgical and non-surgical rehabilitation protocols have recently become quicker, shorter, more aggressive, and more successful. It used to be that patients who underwent surgery would wear a cast for approximately 4 to 8 weeks after surgery and were only allowed to gently move the ankle once out of the cast. Recent studies have shown that patients have quicker and more successful recoveries when they are allowed to move and lightly stretch their ankle immediately after surgery. To keep their ankle safe these patients use a removable boot while walking and doing daily activities. Modern studies including non-surgical patients generally limit non-weight-bearing (NWB) to two weeks, and use modern removable boots, either fixed or hinged, rather than casts. Physiotherapy is often begun as early as two weeks following the start of either kind of treatment.

The relative benefits of surgical and nonsurgical treatments remain a subject of debate; authors of studies are cautious about the preferred treatment.[4]  It should be noted that in centers that do not have early range of motion rehabilitation available, surgical repair is preferred to decrease re-rupture rates.[5]

Rehabilitation: There are three things that need to be kept in mind while rehabilitating a ruptured Achilles: range of motion, functional strength, and sometimes orthotic support. Range of motion is important because it takes into mind the tightness of the repaired tendon. When beginning rehab a patient should perform stretches lightly and increase the intensity as time and pain permits. Putting linear stress on the tendon is important because it stimulates connective tissue repair.  Doing stretches to gain functional strength are also important because it improves healing in the tendon, which will in turn lead to a quicker return to activities. These stretches should be more intense and should involve some sort of weight bearing, which helps reorient and strengthen the collagen fibers in the injured ankle. Such as the toe raise on an elevated surface; the patient pushes up onto the toes and lowers his or her self as far down as possible or better yet, foot work on the Pilate’s reformer.

The other part of the rehab process is proper alignment of the foot.  This can be achieved with orthotic support or with Pilate’s reformer footwork training. This doesn’t have anything to do with stretching or strengthening the tendon, rather it is to keep the patient comfortable and place them in as proper alignment as possible. Custom made shoe inserts can be made to help maintain proper pronation of the foot.  If ankle and foot alignment are compromised, it can lead to further problems with the Achilles.

To briefly summarize the steps of rehabilitating a ruptured Achilles tendon, you should begin with range of motion type stretching. This will allow the ankle to get used to moving again and get ready for weight bearing activities. Then there is functional strength, this is where weight bearing should begin in order to start strengthening the tendon in proper alignment and getting it ready to perform daily activities and eventually in athletic situations.[6] [7]

 

Original articles adapted from Soslowsky Laboratory projects, Perelman School of Medicine and
Wikipedia, the free encyclopedia

 

References:

[1] Allenmark, C. (1992). “Partial Achilles tendon tears.” Clinics in sports medicine 11(4): 759-769.
[2] Suchak, A. A., G. Bostick, et al. (2005). “The incidence of Achilles tendon ruptures in Edmonton, Canada.”Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society26(11): 932-936.
[3] Richter J, Josten C, Dàvid A, Clasbrummel B, Muhr G (1994). “[Sports fitness after functional conservative versus surgical treatment of acute Achilles tendon ruptures]”. Zentralbl Chir (in German) 119 (8): 538–44.

[4] Nilsson-Helander K, Silbernagel KG, Thomeé R, et al. (November 2010). “Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures”. The American Journal of Sports Medicine 38 (11): 2186–3.

[5] Jump Up Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M (December 2012). “Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials”The Journal of Bone and Joint Surgery. American Volume 94 (23): 2136–43.doi:10.2106/JBJS.K.00917.

[6] Cluett, J. (2007, April 29). Achilles Tendon Rupture: What is an Achilles Tendon Rupture. Retrieved May 6, 2010, fromhttp://orthopedics.about.com/cs/ankleproblems/a/achilles_3.htm

[7] Jump Up Christensen, K.D. (2008). Rehab of the Achilles Tendon. Retrieved May 6, 2010, from http://www.ccptr.org/articles/rehab-of-the-achilles-tendon/.htm

Body equilibrium – how Pilate’s develops strength from the inside out.

Pilates training develops the necessary strength and mind-body connection to hold our spine, joints and bones in the most anatomically correct positions, enabling us to move more effectively.  It develops the deep muscles which support our skeleton, allowing a more balanced body and connected core.  It helps eliminate creaky hips and shoulders, and trains you to develop better spinal mobility, and placement during exercise.  With this we can train harder, work harder – in general – move more efficiently and with less likelihood of injury no matter what we do from construction to desk work.

Yes, it focuses on the core, yet core does not just mean abs and back.  We in Pilates refer to the core as the deepest layer of muscle which is closest to our skeleton.  These are the local stabilizers which control neutral joint position and segmental motion.  They provide proprioceptive input about joint position, range, and rate of movement. They are also active continuously during movement, thus are endurance type muscles. When there is muscle pain, injury or movement impairment the stabilizers become inhibited and since they control joint placement our body no longer can stabilize itself or we cannot hold our spine or joints properly.  When this happens, our larger more superficial muscles called global stabilizers, have to work harder, become overactive and react to this pathology with spasm.

Stability retraining can only be accomplished with low load core conditioning focusing on the mind-body connection, to retrain motor control and endurance.  Pilates works our body starting with the deepest muscle layer outwards.

The video below is a great example of these principles – this isn’t a normal squat:

Pilates training is essential to any fitness program.  With its emphasis on alignment, breath, total body conditioning, it educates the participant on proper form and function.  The following video demonstrates how paying attention to alignment can greatly increase the challenge of an exercise;

It makes one mindful of how to stand, squat, flex, extend, bend and move in a stronger more stable way.  If you do not develop and  connect with your core muscles no amount of weight lifting, squatting or cross training will change your physique.   In fact you may well continue to develop muscle bulk as the global or superficial muscles continue to over work while the deeper intrinsic muscle layer fights for stability.  Stop the battle!  Let Pilate’s balance your strength and flexibility  – develop body equilibrium.

 

By Samantha T. Reed

Reference: Injuries and Special Populations Manual, Stott Pilates, 2010.