Podcast #127: Tendons with Nils Heim

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https://podcasts.apple.com/us/podcast/jacked-athlete-podcast/id1462537296?i=1000697191172

A weaker tendon and a stronger muscle: “it only makes sense for bodybuilders, know, just people that train their calves just with maybe let’s say higher reps and not that much of a weight that doesn’t really increase the stiffness or all the structural capabilities of tendons. And the calf just gets super big and super strong and the tendon lags behind.”

“There are many things that can influence pain, right? So we can do many kind of exercises and stuff that changes the pain. And on the other side, there may not be any kind of structural changes. And this might be enough for some people.”

“For people with Achilles tendinopathy, if they didn’t have any increase in stiffness whatsoever over the course of the rehab period… this result may be totally fine for just sedentary people or just the more the metabolic group that just needs to do some kind of loading…. While on the, on the other side, athletes need to increase their stiffness. If they don’t, they just lag behind in performance, probably at a higher risk of, of, of rupture in the future, I guess, because the tendon will have so much more strain.”

“You see it’s just some people that are super, super weak and you have to really make sure to get them stronger and there’s 100 % a benefit if these people get stronger. And on the other hand, you have people that are really strong and obviously they do not have to be so much stronger.”

“Some people get better with wait and see. And some people don’t. And I feel like we should treat everyone from the start, like it doesn’t get better from wait and see.”

“It probably didn’t get better because of the intervention (shockwave, injections, etc.) that they did here, but because of wait and see.”

“I think, it’s way more frequent that we have both patellar tendinopathy and patellofemoral pain.”

PT vs. PFP: “at the end, you just take some exercises, try them out, and then you see what works and then people get better, right? Because the activation of the quads get better, they get stronger in the hips, in the hamstrings, adductors, calves, foot, and all that kind of stuff. And so I feel like it doesn’t matter that much.”

Patellar tendon pain: “if it can only be triggered by high intensity loading. jumps, cuts, sprints, all that kind of stuff. And heavy isometrics, heavy slow resistance isn’t provoking the pain. And if you, if you take that diagnosis, then the group of people that have that gets very, very small, I think.”

“All the cases that I have had that were complicated, let’s say very long lasting pain, were always, always insertional.”

“So, and that’s the tricky part of, of insertion, Achilles tendinopathy, because it’s for people that have a quite an active lifestyle. Let’s say just walking around having a dog taking it for a walk every time, or maybe living uphill and having to walk up the hill every day, multiple times. Their Achilles just gets triggered every time that they do their daily life. And if they are in the position that, or in the situation that their PT or their doctor just told them to rest for let’s say six, eight, 12 weeks. And they just got so weak and so deconditioned that like everything triggers that. And then they just got into this, yeah, into this circle where they just couldn’t can’t, can never get out of it.”

Tendons and compression: “And the other thing is just getting used to it. It’s like a Thai boxing guy who just chops down banana trees to get the shin conditioned, right? And it’s, it’s not a, like a really trainable capacity. Did you know what I’m, what I mean? It’s, it’s, it’s a, I differentiate between the two and then, what I, if, people train at home, usually the insertion is more elderly people. then I would just have them do their calf raises and then just add like a newspaper or magazine every week, just to increase the point of where they’re standing at. And so it increases the stretch very, very slowly, very, very gradually. And they can get used to that. And that usually works pretty, pretty good. Yeah. Okay. The, yeah, I think it’s like the, you’re exposing them to something that might be pain provoking, you know, and then just backing off if you do.”

Adding in daily isometrics on top of training: “Although the isometrics may feel fine and not like, provoking the pain in any way, it’s still load for the, for the the tendon. And you have to like consider the overall load of the, on the, on the patellar tendon over the whole week. and, so what, what do we feel like if, if the, loading overall is just too much, then usually the pain just, starts creeping up.”

“Everyone needs loading.”

“I think that usually the metabolic group is the one that is driven by psychological factors the most from it’s because they are in high fear of rupture. So, and they usually don’t exercise a lot and they have no, usually no feeling for how their body moves and how much pain they can tolerate, how much load they can tolerate.”

Metabolic tendon pain: “So that’s why if you change their diet, change their lifestyle, maybe work with stress management, work with psychological factors and also address the tendon as I said, then this usually is the best combination. Whereas if you have an athlete, mean, you know, they can just give a shit about the diet and their sleep and all that kind of stuff can be quite bad and still they can get better. I mean, it’s not ideal by any means, but they can still get better.”

“So if you just address it from all the angles, then the chances of it getting better is way higher than with people like athletes like where it’s very biomechanical driven. it’s more just about the load itself and not all the environmental factors in the body.”

Alcohol and tendon pain: “if it doesn’t get better, maybe you should stop at least for let’s say two months and try to do your rehab stuff… If that’s alcohol that is shown to have a negative impact or maybe to increase the risk of developing tendinopathy, leave it out. It’s just better for you.”

“If I compare my clients from the start and at the end, everyone got stronger. And this may be due to the pain going down and the inhibition is just reduced. so the body just sets free kind of sets free more strength.”

“I had one guy with patellar tendinopathy that he was, he was doing like, step downs with, I think, 32 grams, kilograms, a kettlebell additionally, which is, I mean, it’s kind of a pistol squat, right? So with 32 kilograms additional weight, that’s pretty impressive. And he had huge quads and he had patellar tendinopathy on both sides, playing football, so American football and, then he just showed me his training and it was like three times a week, eight times six, 10 times five, squats, Bulgarians. like three different quad exercises. And then it was just a matter of load management for him because he got his patellar tendinopathy, because he was just torturing his tendon because he did so much volume on that. And so he could, couldn’t become better. And, he didn’t get stronger at all. in, in, the, in the process, he just, we just, I, I cut out, I think two thirds of his squad training because it was just too much. And then the pain started going down. And, and I think that this is one of the prime examples where it’s not about strength, right? it’s just about, the right amount of load.”

Nils on Instagram: https://www.instagram.com/nils.heim.schmerzcoach/

SehnenStark podcast (iTunes): https://podcasts.apple.com/us/podcast/sehnenstark/id1725984010

SehnenStark podcast (Spotify): https://open.spotify.com/show/63h1RG0X1ZCoWwT3Z0MgZ1?si=b0193eed8f604635

117 thoughts on “Podcast #127: Tendons with Nils Heim”

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