Osteoblasts : go, you good things!

Growth bone cells to the rescue.

Isn't it crazy to think that your bones are constantly changing? Always in a state of flux. It is the battle of good vs evil, with the osteoblasts  battling against the osteoclasts.   

High-impact exercise, such as running and jumping, increases osteoblastic bone cell activity due to the mechanical strain and loading placed on the bones. When bones are subjected to high-impact activities, the mechanical forces stimulate osteoblasts, which are responsible for bone formation and mineralization.

The strain and loading experienced during high-impact exercise create micro-damage in the bones. In response, osteoblasts become activated to initiate the repair process. These cells start depositing new bone tissue at the sites of damage, reinforcing the bone and making it stronger. Furthermore, high-impact exercise triggers the release of growth factors and hormones, such as insulin-like growth factor (IGF-1) and estrogen, which also enhance osteoblastic activity. These factors promote the proliferation and differentiation of osteoblasts, accelerating bone formation.

Consistent high-impact exercise over time leads to a cumulative effect on bone remodeling. The increased osteoblastic activity results in a higher rate of bone turnover, leading to the replacement of old or damaged bone with new, stronger bone tissue.The increased osteoblastic activity stimulated by high-impact exercise helps to maintain bone density, prevent osteoporosis, and reduce the risk of fractures, particularly in postmenopausal women and older adults.

Make it simple.

Here are 3 easy ways to get your osteoblasts raring into action:

• Pogo jumping up and down on the spot. Try this for 1 minute each day. Too easy? Try pogo hopping instead.

• Step ups, with a deliberate stomping action. Step downs with a stomp can pack a punch too. Try this for 1 minute each day on the bottom step of any set of stairs. Use the rail if your balance needs a little support.

• Wearing a weighted backpack for the above exercises will increase the impact and bone response even more. Pop a couple of hand weights or plates in a strong backpack, secured firmly on your back. Your osteoblasts will rise to the occasion!

So, in the war of osteoblasts vs osteoclasts in strong and healthy bones, we really need to get our little bone making cells stimulated. It is up to us to make that happen and to prevent aging conditions such as osteoperosis. 

Tendonitis and tendinopathy are a common complaint seen within the physio clinic. Tendons can get all angry with you if you load them up too fast or too soon ( think training for only 2 weeks before the City to Surf and then hitting that race day a little under prepared), if you do not allow enough rest between exercise, or even if your postures are not ideal and joint alignments not too flash. Age, and for women, menopause, can all be factors that cause our tendons to become inflamed.    

But don't despair, that Achilles tendon, rotator cuff shoulder tendon, tennis elbow tendon or knee cap tendon can all adapt back to being strong, not inflamed and ready for the work you wish to put though them. This is called tissue adaptation, and it is what keeps our bodies sometimes breaking down, but then allowing for healing too.  

The vicious cycle

"Why, in the first place did my tendon go all silly on me?"

"OK, if I rest from that triggering activity, will it get better?"

"Sure, but if it is only rest you do and you go back to the same triggering activity, what do you think may happen?"

"Hmm, I see a cycle developing here."

Tissues, like your tendons, need to withstand the pulling and tensile forces you put though them. If they are overwhelmed and cannot, then trouble starts a-brewing. To improve their ability to withstand these forces, you must stimulate them to become stronger, to thicken, to be able to absorb the forces. We want and need them to adapt, and to do this, you must challenge them. And yes, this means exercise, and even when they are still inflamed and you are 'resting' from the triggering activity.

The right kind of tissue adaptation

So, what is the right exercise to do when your tendon needs strengthening but is also going through a rough patch of inflammation? Tendon loading! Your amazing physiotherapist should know all about this and would be there to set you up on a targeted program just for you and your unhappy tendon. However, here are the basics:

• When you exercise a muscle, you also exercise it's tendon. By targeting the muscle very specifically, mindfully and with a few little rules, you can achieve a stronger tendon while you are resting from your sport and any chance of ongoing inflammation.

• Exercising an inflamed tendon, may make it hurt a little, but this is often what we are after. What?? A little pain at the time, with no lingering issues or inability to go about your usual daily activities is perfectly acceptable. We use the pain scale out of 10 for this one, and would recommend that pain levels with your tendon loading exercises of up to 3/10 is OK. Anything more, or if it's stirred up for days after, then, yep, the tendon is not happy with its little workout. It often takes a little adjusting of your exercises to get it right.

• Exercise to fatigue. When you are isolating a muscle like you do with these tendon exercises, we want you to achieve that burn, quiver, or "I just can't do another rep" feeling in the muscle. Playing around with the weight or load you have for your contractions help you to reach this point without having to do 200 reps!

• Slow controlled movements work best. Really demanding a long 'time under tension' of your tendon will yield great results, especially in the eccentric or lowering phases of your movement with gravity.

• Offer a progressive strengthening program, increasing the weights as weeks tick by and fatigue is harder to reach. Do keep in mind the 3/10 pain levels here. You do not want to go backwards. However, on a positive note, healing will take 6-8 weeks, and inflammation levels will be decreasing if you are dong everything right.

• Offer a graduated return to sport and that triggering activity. Have you tried some sport specific activity that tests the tendon, but not as a full blown 2 hours tennis match with your tennis nemesis? Go for a hit up against the wall for 10 minutes, softer shots, not as long a time to stress your tendon. How did it go? How was the tendon soreness after? All good? Increase your time at the wall. Same goes for a return to running with an Achilles, patella or hamstring tendinopathy. Jog/walk programs are the best at gradually loading up that tendon that got angry with all your running prior.  

So, don't let a tendon injury beat you down. There is plenty you can be doing to make it a better and stronger tissue. I bet that this 'new' tendon of yours may be even better than the one you had before the injury. 

We physios talk a lot about the rotator cuff muscles of the shoulder. This includes their importance in shoulder stability and biomechanics, aiding in a good alignment of the humerus in the joint, the posture's effects of over loading and stressing these muscles and of course injury and pain at these very tendons and muscles.

Visualisation of these muscles and where they sit at the back of the shoulder and shoulder blade is super valuable. This simple picture can allow you to see why they are so important and at risk of injury or wear and tear over the years.

✅When working well, they hold the ball of the humerus into a good position within the shoulder joint 'socket' and stop it from rolling too far forward in the joint.

✅If your posture if too slumped or rounded at the shoulders, the work of these muscles is greater than it should be, often causing inflamed painful tendons, or 'tendinopathies.'

✅Shoulder bursitis and tendinopathies of the rotator cuff occur when the space available for these structures is compromised. Swelling, thickening, and inflammation can fill the small space under the acromion, causing pain and injury to the structures that lie below. This is called impingement and is very common.

✅Shoulder impingement issues can occur acutely or over a long period of time. Poor shoulder posture, excessive overhead and reaching activities, or imbalance of exercise at the gym can all cause these slow burning issues.

✅Sometimes the wear and tear of the impingement can cause tearing of the tendons, most commonly the supraspinatus muscle due to its location right up the top of the shoulder tip.

✅Conservative management of shoulder impingement issues involve lots of postural work (freeing the tight muscles at the front of the shoulders, stiff necks and upper backs) and strengthening of the upper back and the rotator cuff itself. Surgical management can range from scraping and creating more space up in the top of the shoulder, to stitching and repairing torn tendons, to relocating tendons with screws into the bone for more complicated operations. Recovery and rehab is a long long journey for some, with physios and clients spending months of time together!