Lecture Notes: Dr. Gabrielle Lyon Show with Dr. Gerard D'Anzafo

Introduction

Guest: Dr. Gerard D'Anzafo, a Physical Medicine and Rehab Doctor
Episode Focus: Beyond muscle health—tendons and their key role in longevity and overall health

Education: Chief Resident at Columbia and Cornell, Fellowship in Spine and Sports at Hospital for Special Surgery (HSS)
Specialty: Physical medicine and rehabilitation (Physiatrist)
Role: Non-operative specialist focusing on disability and ability spectrum, human movement, pain, function
Experience: Worked with stroke, hemiparesis, hemiplegia patients, spinal cord injuries, professional sports teams (Nets, Red Bulls)

Combines Neurology, Orthopedics, Internal Medicine
Patient Care: Addresses mechanical issues in human movement, non-operative treatments for pain and dysfunction
Focus: Biomechanical determinants of pain (e.g., shoulder pain stemming from shoulder blade dysfunction)

Previous Experience: Personal Trainer
Special Interest: Exercise and its role in physical medicine, close collaboration with physical therapists

Structure: Tendons connect muscle to bone, made predominantly of collagen
Function: Viscoelastic properties—dissipate energy at low strain; high stiffness at high strain
Importance: Essential for efficient muscle function and movement; poor tendon health impairs muscle functionality

Building Tendons: Critical to develop tendon strength and thickness during youth for lifelong resilience
Decline with Aging: Tendons lose stiffness, collagen content, and cross-sectional area

Tendonopathy: Characterized by chronic disrepair, micro tears, nerve rootlets causing pain
Common Sites: Rotator cuff (shoulder), Achilles, patellar (knee), glute tendons
Sources: Overloading tissues, lack of stability, improper training load management

Training: Ensure balance and stability in all three planes (sagittal, transverse, frontal)
Exercises: Use kettlebells, rotational work, single-leg stability exercises (e.g., skater squats, suitcase carries)
Monitoring Load: Progressive overload should be managed carefully; incorporate rest and recovery
Cross-Training: Engaging in various movements (e.g., Plyometrics, dynamic stretching)
Restorative Work: 80/20 principle for exertion vs. capacity-building activities
Address Pain: Seek medical advice if experiencing recurring pain (e.g., during nighttime)

Thyroid Hormones: Prevent cell apoptosis in tendons; hypothyroidism linked with tendinopathies
Estrogen: Plays protective role in tendon and ligament health; crucial during different ovulatory phases
Testosterone: Appears beneficial; synthetic analogues (anabolic steroids) pose risk

PRP (Platelet Rich Plasma): Utilizes growth factors to stimulate tendon healing
PNT (Percutaneous Needle Tenotomy): Converts chronic disrepair to acute inflammatory phase
Ultrasound-Guided Treatments: Ensures precise intervention, preventing further damage

Pros and Cons: Provides short-term relief, but may impair tissue healing over time for some patients

Strength and Stability: Prioritize exercises that offer stability through ranges of motion
Farm Hand Strength: Incorporate functional movements throughout the day (e.g., kettle bell swings, push-ups)

Stretching: Static stretching post-exercise may benefit tendon elasticity and recovery
Loaded Exercises: Promote tendon health (e.g., Eccentrics)
Avoid Over-Training: Incorporate periodization, monitor joint and tendon health actively

Diagnostic Precision: Using imaging (MRI, ultrasound) and thorough physical exams to guide appropriate interventions
Individualized Care: Tailored rehabilitation programs focusing on root causes of dysfunction

Regenerative Medicine: Continued study and refinement of treatments like PRP, stem cells
Prevention: Greater emphasis on injury prevention through biomechanics and early intervention
Comprehensive Care: Integrating nutrition, hormonal health, biomechanics for holistic treatment

Takeaways: Importance of understanding tendon health in correlation with muscle function, comprehensive approach in diagnosis and treatment