🔴 En Directo con Ana Galeote: Tendinopatía del Manguito Rotador del Hombro

Hi guys, good afternoon. Good afternoon to everyone, how are you? I had to sit down for a while and talk to you. Tell me in the chat if you hear me well, the check of each day. If you see me well, if you see me well, if everything is fine. How are you? Where are you listening to me from? All those things. I think the comments don't appear in the chat until after 60 seconds or something like that. So the first minute is always a bit weird, I'm talking to myself. Well, today we are going to talk about shoulder tendinopathy. Tell me in the chat, let's see if I can appreciate the messages in the chat. We are going to talk today live about shoulder tendinopathy. Today, guys, I don't have much time because I have a meeting at 7.30, so I'm going to have to cut that. Hi Rosana, I read you, I read you. I'm going to have to cut that at 8.25. So let's go, let's hurry up a bit. Hi Adriana, always here. Thank you for being here guys. Hi Joaquin. Vanessa. The comments are coming, the comments are coming. I have to learn how to reconfigure the broadcast so that they can appear before me. From Argentina. Hi Francisco. Vanessa. I'm in Madrid. Hi Jazz. I'm in Madrid and I have to tell you that next Monday I won't be able to do live. Vanessa from Menorca. Ana from Argentina. Hi Carlos from Guayaquil. Hi guys. Hi Cesar. Next Monday I won't be able to do live because we're going on a trip this weekend to celebrate my birthday and our anniversary. So we'll be back on Monday and in the afternoon I'll be in the car driving, so I won't be able to. So we'll see each other in 15 days. Just so you know that if you don't see a programed broadcast, it's because of that. Well, today we're going to talk about shoulder tendinopathy. I don't know if you've seen it already or if you're on my email list. We have an email list where I send emails a couple of times a week warning about the live broadcasts, the work, the protocols we get from Healthy Movement, from the videos I upload to YouTube. And we've come up with a specific protocol for shoulder tendinopathy, specifically for athletes. So I'd like to take advantage of the fact that we've come up with it, to explain my principles when it comes to treating a tendinopathy so that we have clear principles. Because for me, a part of all the protocols we have in Physiogods, beyond the exercises or rehabilitation program, all have an important educational component. Because in the end, whenever we go through an injury, the most important thing is that we understand the factors that have influenced that injury to appear. That we understand, obviously, a little bit of anatomy of the shoulder, the hip, the knee, a little bit of biomechanics, and that we also understand the pain. Why is there pain? Why does it arise? And how can we control that pain? How can we manipulate it so that we don't feel lost and a little bit with nothing to do when that pain appears and that we have strategies to alleviate it. So today we're going to talk about three key concepts. Then, if we have time, as I have to leave at 8.25, if we have time and there are doubts about it, we'll see them. But today we're going to talk, above all, about the rotator cuff, which is that a lot of shoulder pathology is related to the cuff. And we're also going to talk about which factor is the most decisive when it comes to preventing a tendinopathy and rehabilitating it. And we're also going to talk a little bit about supplements that can help us. Okay? Look, here Anxo asks me, after a supraspinous surgery, how would the correct physiotherapy be focused? In my case, two ecographies, a disinformed suprabursa, and calcification, which is the one that is supposed to give me pain. Okay. Let's see first, let's talk a little bit about all the topics that I have written down here. Maybe that already gives you a lot of information and solves your doubts. And so, in the end, we're going to talk, we're going to see specifically the doubts that have been left, in general, the time it gives us. First, we have to know what the rotator cuff is. I don't know if you know or don't know. I have here my shoulder, which I really like to use to explain things well. A super important thing that we have to be clear about is that the shoulder, as well as the hip, due to the shape of the head that is inserted, will always need to be able to rotate for any movement. In fact, when we talk about the rotator cuff, it is because in that cuff there are muscles that intervene directly in that shoulder rotation movement. Let's do a little bit of palpatory anatomy, those of you who are here, so that you can feel it well. First, I want you to palpate at the level of your shoulder and you are going to palpate the clavicle, this clavicle that is born in the sternum. You are palpating it, you are following the clavicle with your fingers and you are going to see that at the end of the clavicle, if we continue to advance, we will see that up here on the shoulder we have another bone provenance. This is the acromion and this is the union of the clavicle with the scapula. The acromion is part of the scapula. In the shoulder joint there are several joints in itself. Then we have on one side the humerus, which is this bone that comes here. Then it is articulated there with the clavicle, I hope you can hear me well, and from behind with the scapula. We are going to palpate the scapula. If you take it with your hand and palpate it just behind, you will see that the first thing you feel is like a bone provenance, which is like another clavicle that we have here behind. It has a little bit the same shape. That is the spine of the scapula. The scapula is the shoulder joint, which is the most common word. Here we have three different bones. We have the clavicle, we have the scapula and we have the humerus, which also intervenes. We have to know that the scapula is placed on top of the ribs. Therefore, there is also another joint that exists more or less between the ribs and the scapula. And then we also include the clavicle. In the shoulder complex we have to take into account that the clavicle also articulates with the sternum. So, in the end, if we look at it, there are many structures that form the complex, the shoulder joint. What is the rotator cuff? The rotator cuff refers to four muscles. The first is the supraspinous, the infraspinous, the smaller round, Oops! There are balloons here. The first edition has balloons. Supraspinous, infraspinous, smaller round and sub-scapular. Remember when we were feeling the scapula and we felt the spine of the scapula. Well, the supraspinous is the muscle that is placed just above that spine. When we talk about the infraspinous, we talk about a muscle that is placed just below that spine. Then we have the smaller round, which is also on that scapula, but it is a little lower than the infraspinous. And then we have the sub-scapular, sub-scapular and scapular. This muscle is located between the scapula and the rib cage. That is, it is very deep. To access it, we would have to be able to put our hand between the scapula and the ribs. It is very deep there. Let's see where each one is inserted. Here I have the number. This is the number on my left arm. The supraspinous... One thing we have to keep in mind is that the tendons are those structures that bind the muscle to the bone. Always. The tendon is the one that binds the muscle to the bone. Although we humans need to fragment knowledge to understand it, we have to divide it all into muscles, tendons, bones, but in the end, think that a structure is diluted in the next one. It is as if the muscle is converging and there is a point where the fibers really intersect with those of the tendon, and the tendon is inserted into the bone. The supraspinous is a muscle that is above that spine that is going to become a tendon, and if this is the bone of the human, it is going to be inserted right here above. So, think that if the muscle contracts, the action it is going to do is the abduction. It is going to separate the arm from the body. This is the abduction. When we talk about the supraspinous, the supraspinous is going to come from behind, because it is where the spine is, and it is going to be inserted right next to the bone. So, if it comes from behind and is inserted here, the action it is going to do is the external rotation. It is going to rotate the shoulder outward. The smaller round does the same, it is inserted just below the supraspinous, and the sub-scapular that comes from here deep, instead of being inserted behind the number, it passes here in front, it is inserted in this part here, and what it is going to do is the opposite action, it does an internal rotation. So that you can see that this musculature is in charge of that rotation movement that is necessary at the shoulder level. And this is key because when we want to develop a rehabilitation program to treat this musculature, we have to know what movement it performs, what function it performs, so that we choose those exercises that perform those functions, and therefore we train that musculature more directly. Also, of course, we have to take into account that when I perform that external rotation of the shoulder that we said of the infraspinous and the smaller round, I don't just work on those muscles, there are a lot of structures that are working, but when we simplify, we go directly to those functions. Anyway, at the end of the shoulder, when we train or do some rehabilitation exercise, we can focus it in different ways. We can focus it directly, that is, work a muscle directly, thinking just about the function it is going to perform, or indirectly, because in the end it is not going to activate only a muscle when I move it, but maybe I am doing, let's imagine, a movement of press, of push over the head, although this movement is not pure, neither of abduction nor of external rotation, but there are going to be components and that musculature is also going to work to maintain a good stability and a good function of the shoulder. Therefore, we can also work on them indirectly. I won't linger on, we continue to the next point. What is the most important factor at the level of a tendinopathy? When we talk about a tendinopathy, we basically talk about a dysfunction of the tendon. A tendon that, for whatever reason, has started to inflame or has reached a stage in which it is degenerated, that its tendinous fibers have lost quality, have lost structure and are degenerating. The factor that most intervenes in the development of tendinous pathology is the load. In fact, one of the parameters that is used as a physiotherapist to identify when we are talking about a tendinopathy is when the patient refers that the pain of the shoulder, of the knee, of whatever, increases with the load. That is, if that structure, as I increase the load, refers more pain, more discomfort, it is surely related to the tendon. Because in the end, the tendon is one of the structures that makes the movement. Therefore, we are going to notice that pain in the case that there is a pathology when it is working, not so much when it is at rest. We may also feel pain when it is at rest due to inflammation or whatever, but mainly when there is a load. You have to make a good differential diagnosis to determine these things. And then, based on the movement in which that pain appears, we can go a little finer and say, okay, it's about this tendon, this other one, etc. We talked about the load. Whenever we are talking about the rehabilitation of a structure that is designed for movement, we have to think that it is a structure that needs movement to stay alive. Because that, I am simplifying it, because that is its function. So, the moment I take away the function, it loses its structure. Because its structure is made to move. The moment it does not move, it does not make sense for my body to maintain the resources to maintain that structure. I give resources to that structure to keep it. Hence, the moment we stop training, we are going to lose muscle mass, we are going to lose... I was telling you the other day, astronauts, when they go into space, as they do not load, there is no gravity, there is no impact, the bone loses bone density. Because we are not going to maintain a structure that is not used. At the end of the body, we are always going to try to save resources. So, this is the same. But what happens with a tendon? Just like with adequate training in which there is a progressive load, little by little I am subjecting it to a greater load, my tendon is strengthening and is being more capable of tolerating it. At the moment I put an excessive load for what is prepared, it does not have to be a day, but if it is repetitive, in the end, my tendon goes into dysfunction. Why? Because it is not capable of dealing with that stimulus. So, it starts... This is the cascade described by Cook and Purdan in their theory of continuity. And according to them, what happens is that the moment I put too much load on a tendon, the one that can bear it, first it will begin to stiffen. We do not have to feel any kind of discomfort there. Simply the tendon will be a little more rigid, which even in certain people is something that can be looked for, because the more rigid a tendon is, the greater its reactivity will be. Imagine, for example, in a sprint runner, he will have to run very little time and so that when he takes the step, the ground... In the end, the moment I put a force against something, I receive the same force back. This is how we walk, this is how we run. I give an impact to the ground and the ground gives me back that force. In the sprint, for example, when I give a good impact to the ground, the ground gives it back to me and if my tendon here is very rigid, it will be able to save a lot of energy to then continue that race. There are certain cases where that rigidity of the tendon is even desirable. But we continue there, we continue to put load on it. What is the next thing that will happen? The tendon will enter a state of inflammation because it is not able to repair itself, to adapt to the load and it will enter a state of inflammation, which is where tendinitis is usually found. If I have tendinitis, I regulate the load so that my body alone resolves that inflammation, I give it a little bit of relative rest, but I keep moving my shoulder, because in the end, with time, my body is able to manage that injury, that damage, and it heals again. Imagine that I have that inflammation, even so I don't stop and I keep subjecting my tendon to more and more load. According to Kukipurdan, here what happens is that the tendon can't take it anymore and it begins to degenerate. The fibers begin to break, and so on. So it's like a waterfall, where little by little my tendon loses capacity and degenerates. What is the solution? The solution is to reduce that load, without stopping moving it, but to reduce that load enough so that my body is able to regenerate that tissue and thus solve that process. So what are the factors that can influence the load? I have 5 minutes left. What can influence that load? Well, obviously, if I put more weight, more load, more repetitions, more load, more intensity, more load, more training days a week, more load. If I sleep less or I sleep worse, how worse? Well, in the end, in the face of the same stimulus, my body will feel as if it was a greater load. Therefore, it is necessary to regulate not only the pure load of the rehabilitation training, but also to regulate our lifestyle, because it will make the immune system work. Inflammation, and the last detail that I wanted to tell you, to see your comments, I don't want to leave without reading some, is what supplements or what we could do to make it easier for our body to carry out that process and that our immune system takes care of improving that regeneration process and solving that inflammation, getting rid of everything that serves us, the damaged tissue, etc. The first thing, and I have already mentioned it to you before, is that we need a quality sleep and a quality nutrition, because without that, our immune system will not work well. And an essential part of nutrition is protein. In the end, our tissue, our tendon, our muscle is protein. If we are in protein deficit or we are not regular with our protein intake, we are not doing any favor to our body so that it can generate more tissue. Ok? Another, and then a couple of supplements that can come in handy, I don't know if you know it, but I made a post on Instagram a little while ago about it, one is collagen. Although it has always been said that collagen is a little weird, because its effect was not very clear in the cartilage or in the muscle. In the muscle it does not seem to be super useful, but in the tendon it is, because the tendon is 65-85% collagen. Therefore, giving it that supplement will make those amino acids more present in the plasma and therefore new collagen can be regenerated. The collagen that is always accompanied by vitamin C, which normally all supplements carry it, ok? But make sure that you can make a good synthesis of new collagen. And then also, when we are talking about a tendonitis or an inflammatory process, omega-3 of animal origin, EPA and DHA, will collaborate in that both that inflammation exists, because that inflammation has to exist for our immune system to repair, as for it to be resolved. Our body alone, when we are well, maybe there is no pathology basic immune, or autoimmune, can generate that inflammation and at the same time solve it, ok? So omega-3 of animal origin, EPA and DHA, will facilitate that, that inflammation occurs and at the same time that it is resolved. And that is super important. Well, and 24. I have already spoken what I had to speak. I'm going to see your comments. Any questions you have put me? Furious says, What do you think of the epinephrine and soleopathy? Well, in general, what I have heard is that epinephrine at the level of tendinopathy has very good results. I don't think it's the only thing you have to do. Remember that in the end the tendon needs load because it is the function of that tissue, it is for what it is. Always remember that we want to accompany the physiotherapy treatment with the load. That is super important. Anxo asks another. Is magnetotherapy good for regeneration after surgery? From what I know, Anxo, magnetotherapy is used much more with bones. I would have to check the evidence for the tendon. I have it here, the alarm that is ringing me. More for bones than for tendon. I would have to check that evidence. Yas, Ana, are you going to talk about shoulder problems? I always have a shoulder pain, tendinopathy. I would like to activate it, reinforce it. I don't want to be limited. The protocol that we just got out of tendinopathy is mainly focused on athletes. Because it is very focused on a weight work, where a good basic physical condition is needed and very focused on the return to training. But we have another shoulder protocol that is more focused on pain, to a very large functional impotence, to start working mobility, basic stability. So, if you want, send us an email to team, team, and there we can evaluate if there are any of these two protocols that are good for the point where you are and for your goals. What else? If one of those four muscles is inflamed, will there be pain? That is a very good question, Luis Antonio. It may be. The normal thing is that yes, when there is an inflammation, there is pain. But I also tell you that, especially in cases of degenerative tendinopathy, or even broken tendons, that the person does not feel pain. That also exists. That also exists, because not always pain is accompanied by injury. Can I have an injury and not have pain? I can have pain and not have an injury. Come on! And 27. One more minute. Let's see. Belén says, sub-scapular partial rupture. What to do? Well, you would have to evaluate many things. First, see exactly what the doctor sees you, your physio, see a physio who works with an echograph to evaluate it well, at what point it is. But basically, when a tendon is broken, and there is a partial rupture, you need to give it time. That is, your body needs time to regenerate that tissue. In a minimum tendon, it will be three months until it consolidates or the tendons begin to mature, which are the cells that will create a new tendon. And in the meantime, what you can do is try to facilitate that process to your body, eating very well, sleeping very well and maintaining the movement. Try to maintain as much movement as you can so that you do not lose capacity, that you do not lose strength, that you do not lose resistance, that you do not lose mobility. And depending on where you are, because this depends on each one, gradually introduce the load so that as these new cells settle, they acquire that ability to withstand load and mature at a good disposition. But then, of course, if you go to the physio, maybe he can help you with EPI or with other types of Indiva therapies or whatever resources he has to optimize that process and help your body. And one last question. Miguel, I think I just answered you what is the difference between your tendinopathy protocol and shoulder rehabilitation? It depends a lot on the symptoms and the point in which you are. The shoulder protocol is more focused on people who have a very large impotence, where you can hardly move your shoulder, it hurts you constantly and a much more basic work is needed, a lot of stability, a lot of mobility, very little by little, while tendinopathy is more focused on those people who have discomfort when you hang from the bar or when you load from 80% in very final ranges and in more specific movements. And Gustavo asks, one last question, I have improved a lot with your exercises, he asks about a de-inflammatory ointment. I don't know de-inflammatory ointments and the question would be why are you going to use a de-inflammatory ointment? Do you really need it or not? You have to check well why we are going to want to de-inflammate, okay? Maybe yes, maybe we are talking about a process whose inflammation is not natural, but if it is an adaptive inflammation, which is your immune system that is regenerating tissue, then you still have to leave the body to inflame and de-inflammate. Thank you guys, I have to go, I have to start the meeting. Thank you all for coming. Next week I won't be here, I said it at the beginning, but I'll see you in 15 days. A big hug and thank you very much for being here, guys. See you next time. Have a good afternoon.