Podcast #114: Achilles Tendons (Part 2) with Karin Silbernagel


“I think we need to focus on tendon health, not on tendon injury”

“The healthier tendons we have, the less likely we probably are to have major ruptures.”

Collage fibrils runs end to end: “When you have tendinopathy, maybe it’s not rupture of the collagen, maybe it’s changes between the fibers… but when you have a rupture, the fibers are completely ruptured so you get a mop end in between.”

“If the tendon is normally twisted and now it’s untwisted and now you have more tissue around it, the tendon is gonna be longer.”

“The outcomes are not very different if you do surgery or non-surgery.”

“Some people after the patellar tendon rupture have difficulty with full extension and they have an extension lag and sometimes that related to the tendon elongation.”

“You might have swelling, you might have tears between the collagen fibers, but it’s probably not as much discontinuation. Increaased fluid, disorganization, so that’s how we’re thinking with tendinopathy versus in rupture it just tears.”

“What happens probably with tendinopathy is when you’re loading and your turnover recovery gets out of balance… this is probably related to overuse.”

“If you have an environment that might not be so positive, maybe the same load all of a sudden becomes overuse.”

 Achilles rupture prevention: “If you do calf raises, strengthening, try to load your tendon, listen to your body when your performance goes down, and thinking about your overall health.”

“If you’re tying up a boat and there’s not gonna be a storm, you don’t really check your ropes, it doesn’t really matter… but if a storm is coming, you might get some other ropes or make sure there’s no wear and tear in your ropes.”

Tendon strain: “The problem with purely doing stretching, you’re limited by your joint.”

“If you’re stretching, that amount of force is a lot less than the amount of force you’re doing if you’re putting 100 pounds on your back and trying to hold that position.”

“The tendon needs a lot of load in order to get a few percentages of strain.”

“You’re better strengthening at the mid range where you can produce a lot of force.”

“You can get more strain on the tendon when you add electrical stimulation.”

“Maybe electrical stimulation is the way for us to pinpoint the muscle to get enough force to the tendon.”

Is it just about tendon strain? “It’s the peak force, the time under tension, and the rate of loading. All of those three variables we can change.”

“You can have a lower peak load and longer TUT, high peak but lower TUT. You can manipulate both of those variable to not overload it or overuse it.”

“The patellar tendon is very flat, broad, and it’s thicker at the center.”

“Patellar tendon hole is right at the center… with the Achilles tendon, there is no donut, there is no hole… maybe it’s occurring more in the shift between the different subtendons.”

Foot posture and Achilles tendon health: “We can’t find anything.”

“There’s nothing to say that if you have somebody that pronates they’re gonna develop Achilles tendinopathy, absolutely not.”

“We’ve looked at tendons up to 6, 7 years and you still see this callous… it never goes back to looking like the other side but people function well.”

“Everybody you see with a rupture, you can tend to see the medial gastroc looks a bit smaller.”

“When you have an elite athlete, we are very worried about going non surgical because everyone is worried about not doing anything.”

“You want to do so many things instead letting the body work (even if you can’t see it).”

“Is there a difference between overload (e.g., intense load) tendon injuries versus overuse (e.g., volume load)? When you have the rupture, is that more of an overload injury versus tendinopathy, is that more of an overuse injury?”

“The risk of rupturing is very very small so it’s easy to double that risk.”

Fluoroquinolones: “It changes the tendon within 8 days… you have to be careful with high loading rates… that’s where you’re going to be more vulnerable.”

Fluoroquinolones: “If you know something can cause it that bad, maybe in the future we can find something that can help tendon that quickly.”

“The biggest thing with a tendon is that it takes time, but a lot of times we have to entertain the patient in the meantime”

“You need to exercise, you need to load the tendon, it’s gonna take 6 months, in order for people to do that, you need to keep them excited to do that.”

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