TISSUE REPAIR THERAPY (TRT)
Tissue repair is influenced by the positive influence of biomechanical energy (movement and exercise) and biochemical energy (hydration and nutrition). If you are looking to safely accelerate healing from an acute injury or surgery, or play longer on an old injury, put the TRT approach on your team. Working within the safe limits of post-op or acute injury healing time frames, the TRT approach applies the types of mechanical stresses to tissues to accelerate cellular metabolism for healing, removal of waste products and reduce pain. Rest is not the answer to accelerating healing. Throw the “R.I.C.E.” away and use Movement as Medicine.
YOU MAY HAVE HEARD OF PRP, BUT HAVE YOU HEARD OF TRT?
EVEN IF YOU HAVEN’T —TRT IS NOT NEW
The recent trend in avoiding surgery with PRP (platelet rich plasma) and STEM cell injections attempts to accelerate the body’s normal process of tissue repair. Well guess what? You can also accelerate the healing process with properly dosed repetitive movement. We all understand stressing muscles with heavy weight to increase their size and strength. Well tissues like bone, tendons, ligaments, and even discs respond to stress and strain forces, becoming thicker, more elastic and stronger. This concept has been in practice for over a century!
Exercise dosed specifically for tissue repair is not a new concept—though not every medical practitioner knows about it. The version of this type of training was termed Mechanotherapy, coined by Dr. Grafstrom, a Scandaniavian physician who in 1896 described physical exercise intended for tissue repair following injury. Much of his work was centered around training soldiers injured in combat. In the 1960’s Odvaar Holten of Norway, a physical therapist and Olympic coach, developed a more specific education for orthopedic manual physical therapists that directly addressed joint function and tissue repair. The Medical Exercise Therapy (MET) curriculum has become popularized throughout Europe. In the 1980s, Ola Grimsby brought the MET curriculum to the United States, advancing its approach with modern research in histology, neurophysiology, biomechanics, traumatology and work physiology. This curriculum became known as Scientific, Therapeutic Exercise Progressions (STEP). The STEP curriculum continues to grow and advance through clinical practice, training and research. Our innovative care strategies at PT Motion Lab will help you find quick relief.
WHAT IS TRT?
Tissue Repair Therapy (TRT) is the modern day version of applying specific exercise movements that safely stress healing tissue to improve their repair process. The TRT approach can be safely used following an acute injury, following injection (PRP or STEM cell) and following surgical repair or reconstruction. In fact, TRT is the primary intervention needed for these conditions. Unlike exercising muscle, TRT focuses on safe and specific stimuli that activates local cells in the injured or repairing tissues to accelerate their repairing process. This approach requires more advanced training related to tissue repair, as well as exercise design and dosage—just the type of training that MTI Physical Therapy specializes in, provides to their staff and was founded on.
IT STARTS WITH YOUR HINGES
It’s a process…..
- Clear joint motion: if the hinges don’t move right, you can’t train right. Your Annual Checkup or physical therapy evaluation can identify limitations in joint motion that prevent normal tissue stress.
- Clear muscle coordination and strength: your muscles should absorb most of the load, not your joints.
- Design and dose exercises specific to the tissue that needs repair: tendon, cartilage, bone or discs
- Allow for recovery: food and sleep
- Cheat when you can: Blood Flow Restriction therapy
YOU DON’T EXERCISE YOURSELF INTO SHAPE — YOU REST YOURSELF INTO SHAPE
Exercise is actually destructive to muscles, tendons and joints. The stress to these tissues causes microtrauma that weaken them. The initial impact of exercise on the body is very destructive. BUT…it is during the recovery from the exercise, in which cells respond and tissues repair, that the body becomes stronger! That’s why we say “You rest yourself into shape”. If you don’t dose your exercises properly, with adequate rest breaks, nutrition and sleep, the overall impact may not be what you are looking for in training.
The principles of TRT attempt to stress the tissue as hard as possible with safe and pain free loading, while allowing for proper rest periods between daily TRT sessions. The dosage of TRT, how far to move the joint, how fast, what loads, how many repetitions, and how long to rest, can easily be addressed by your OMPT trained physical therapists. Additional benefits of diet and Blood Flow Restriction training (BFR) can also significantly improve the outcome of your tissue training program. It is all about the dosage – too little does nothing, too much can be harmful. Your OMPT therapist can set up a specific program to ensure a positive outcome from training.
WE HAVE TAKEN TRT ONE STEP FURTHER…TO T3
Tissue Training Therapy is our advanced approach to move beyond the initial healing phase and to elevate the tissue’s stress and strain tolerance past the level prior to injury. It’s great to have big muscles, but wouldn’t you also want thicker and stronger bones, cartilage, tendons and discs?
T3 CONCEPTS FOR ECCENTRIC AND ISOMETRIC TRAINING FOR TENDINITIS/TENDINOPATHY
You may have heard of eccentric training for tendinitis/tendinopathy, or maybe have even tried it before. There are many variables that can maximize results, or if not address properly, can prevent this approach from being successful:
- Pure Eccentric Training—refers to only lowering but not lifting the weight. Straining the tendon during the lowering phase. This is used when the tendon is injured at the junction between the muscle belly and tendon.
- Isometric Training—refers to holding a weight for time, without movement. This is used for tendon injuries at the insertion of the tendon into the bone.
- Speed of Pure Eccentrics—slow, each repetition should last 7-10 seconds.
- Time of Isometrics—each repetition should last 5-10 seconds.
- Load—resistance should be as heavy as possible, while avoiding pain and having a normal, coordinated, pattern of movement.
- Length—progress from mid-range training, to fully lengthening the tendon, to combining 3-dimensional strain to the tendon
- Sets—1 set only of 10-15 repetitions. Collagen/tendons fatigue and breakdown occurs with the number of repetitions, not the load. Multiple sets are not performed in one training session, as the collagen does not rest and recover like muscles do within several minutes. These tissues require 4-6 hours between training sessions.
- Dietary intervention can enhance tissue repair, as well as reduce pro-inflammatory foods. Consulting with a dietitian or naturopathy may be needed to maximize the dietary influence.
*Your OMPT trained therapist can assess your needs and dose the program that is right for you. Aggressive T3 programs are initiated only after all pain, impairment and dysfunction have resolved through your physical therapy program, allowing for high-end tissue stress training.
WHAT ELSE CAN I DO
Many variables go into healing tissue and improving performance. The following is just a general list of options to consider to improve your outcome.
- Growth hormone is produced during REM sleep
- Prior to exercise: 16 oz. ounces of fluid 2 hours prior.
- During exercise: 5-10 oz. of fluid every 15–20 minutes, or 20–40 ounces every hour.
- Following exercise: 16 oz. of water for every pound of body weight lost during exercise over a 24-hour period.
*These suggestions may vary based on sweat loss and other related environmental and individual physiological factors.
The amount of energy needed to exercise starts with calculating the resting metabolic rate (RMR):
- For adult women: 655 + (4.3 x weight in pounds) + (4.7 x height in inches) – (4.7 x age in years)
- For adult men: 66 + (6.23 x weight in pounds) + (12.7 x height in inches) – (6.8 x age in years)
Once a RMR is obtained, this figure must be multiplied by a percentage to account for the level of activity:
- Sedentary (no exercise): RMR x 120 percent (i.e., an extra 20 percent on top of the RMR).
- Light activity (no exercise, on feet during the day): RMR x 130 percent.
- Moderately active (exercise 3 or more days a week for 30 minutes or more): RMR x 140 percent.
- Highly active (exercise 5 or more days a week for 30 minutes or more): RMR x 150 percent.
Eating protein is not just for weightlifters and bodybuilders. Endurance athletes need a significant amount of protein as well, to avoid protein catabolism, which is the breakdown of your own tissues to convert protein into amino acids and simple derivative compounds, as a source of energy. Recommendations include: