When I was around 15 years old, I started attending rehabilitation regularly due to issues resulting from the one-sided strain associated with javelin throwing. I went through several centers and saw specialized physical therapists for athletes. I was given exercises to improve my breathing pattern, activate the diaphragm, and perform movements like the 3-month-old baby position in prone or supine, various types of displacements, and the most advanced exercise I could reach, the bear position.
Although as an inexperienced person, I appreciated these exercises positively, I found it challenging to execute them correctly outside the physiotherapist's clinic. Furthermore, most of them were pathological conditions like Achilles tendinitis or golfer's elbow. This situation persisted for several years until I finally understood the appropriate approach that these pathologies required.
Unfortunately, for a long time, I didn't have the opportunity to discuss my sport, biomechanics, and compensatory exercises with experts in the field. It was only when I decided to study sports physical therapy in the Spanish city of Granada that I began to fully grasp the true value of these aspects and how they can effectively help high-performance athletes. (Here you can read about my unconventional professional journey). This discovery propelled me to continue developing myself, and in February 2019, I decided that I wanted to share this knowledge and found my passion for online education.
'A sports physiotherapist should fully understand the nature of muscle injuries and tendinopathies and their rehabilitation'
Sport is very popular, but with it comes the risk of acute and chronic injuries. However, the question remains whether we are really able to properly address these injuries. According to a survey by the STEM/MARK agency from 2018, roughly 14% of the population in the Czech Republic is engaged in running, in the United States it is 18% (NRS, 2020) and in Spain 8.2% (INE, 2020). It is therefore crucial that we have sufficient knowledge and skills in the field of prevention, diagnosis and treatment of these injuries in the sports environment.
From my own experience, I know that many physiotherapists lack adequate knowledge about common conditions such as muscle injuries and tendinopathies. However, these problems are a very common reason for seeking specialized help. According to a study by Cook (2009), for example, tendinopathies account for between 20% and 30% of all sports injuries. Personally, I believe that the true incidence of these problems may be even higher. For instance, a study by A. Scott (2011) found that over half of runners (52%) will experience Achilles tendinopathy over the course of their running career. This number should generate significant interest not only among sports physical therapists but also among athletes themselves, in order to reduce the likelihood of developing tendinopathies.
Often, physiotherapists focus their attention on specialized courses, techniques, and methods, but sometimes they overlook the fundamental essence of providing real help to elite athletes. The problem does not lie in the techniques and methods themselves, but rather in their inappropriate use and the lack of attention to simpler exercises that could truly benefit athletes. It is important to consider that sometimes, just a few minutes of education for the athlete can solve the problem in the long term. In the realm of sports, simple and basic approaches can have a significant impact on injury treatment and prevention.
'The athlete requires appropriate loading, not merely lying on the floor.'
As a biomechanical physiotherapist, I focus on exploring connections between different parts of the body, such as the big toe and the opposing thumb - in a metaphorical sense. However, I consider it a significant mistake to design a rehabilitation plan based on exercises that have no relation to the athlete's movement. Therefore, emphasizing abdominal breathing and rolling on the floor doesn't contribute much to the treatment of muscle injuries, tendinopathies, and the prevention of future sports-related injuries.
When it comes to managing athletes' issues, it is crucial to begin by focusing on the specific local area affected by the injury and then explore other potential biomechanical connections. Gradually, we can incorporate elements into the training program that directly impact that specific area. For instance, in the case of Achilles tendon tendinopathy, it is vital to prioritize force transmission within the tendon in that particular region. Once these aspects have been addressed, we can proceed to address other biomechanical factors such as finger, ankle, and hip mobility, foot strength, gluteal strength, thoracic rotation, among others. Only after these steps should we consider other aspects, like diaphragmatic breathing. This rational approach has demonstrated success both in my role as a physiotherapist and for my patients.
"To induce a change in the mechanical properties of the tendon, it is crucial to apply an OPTIMAL load to it."
Mechanotransduction is a process in which the tendon adjusts to the load it is exposed to. It is crucial to select an appropriate load that provides the tendon with the stimulus necessary for adaptation. In the case of Achilles tendinopathy, when the patient has limited mobility (flexion-extension), even a static position like the bear position can provide the necessary stimulus. On the other hand, excessive loading can lead to tendon overload and worsen its condition.
It is important to design exercises and sports activities in a way that the load on the rehabilitative structures is appropriate for their condition, neither too low nor too high, and progressively increase it. This approach minimizes the risk of injuries and maximizes tendon adaptation to the specific load. Proper planning and gradual load increment are key factors in preventing injuries and optimizing tendon adaptation.
In summary, a precise diagnosis, personalized approach, and gradual load progression are essential for achieving successful rehabilitation and preventing sports injuries. Specialized sports physiotherapists need to possess in-depth knowledge of muscle injuries, tendinopathies, and biomechanics to provide professional assistance and optimal support to athletes. By carefully planning exercises and progressively increasing the load, the risk of injuries is minimized, while the adaptation of the rehabilitative structures is maximized.
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