Episode 135 - Jill Cook, part 2: Loading the Patient in Front of You

Jill Cook PhD, Grad Cert Higher Ed, PG Dip Manips, BAppSci (Phty)

In this episode, #135, I feature the conclusion of my interview of Professor Jill Cook of Melbourne, Australia.  She continues offering specifics on tendon rehab, references of mandatory reading on the topic and what she sees as important for all clinicians in the field of physiotherapy. All this and more on this episode of MCF!



Jill Cook is a professor in musculoskeletal health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. Jill’s research areas include sports medicine and tendon injury. After completing her PhD in 2000, she has investigated tendon pathology, treatment options and risk factors for tendon injury. She’s contributed in producing over 120 research studies just within the past 5 years.  Jill currently supplements her research by conducting a specialist tendon practice and by lecturing and presenting workshops both in Australia and overseas.



Show Notes


Patient Attitudes

Jill talks about the gradual understanding that occurs as pain decreases and strength increases. She speaks about the importance of giving your patients options of things they can do, rather than focusing on all the things they shouldn’t. 


Overcoming Plateaus

Jill speaks on progression of loading, and how plateaus may indicate that the loading strategies were incorrect. She talks about timeframe and loading environments, and the importance of encouraging patients that with the correct loading strategies they should expect progressive improvement over time.


Achilles Tendon Loading Strategies

Jill gives us some guidelines

-Single or double leg isometric loading (5 x 45 second hold)

-Isotonic loading: concentric and eccentric body weight, or seated or standing calf raise with specific resistance (for strength: low repetitions → 3-4 sets of 6-8; for endurance: high repetitions of calf raises)

-Fast paced: skipping, quick stepping, body weight loads with spring through tendon

-Running program or return to sport (focus on strength, no longer emphasizing fast paced activities)

She goes on to speak about frequency of visits and transitions into training, and the most vital aspect of their recovery: education!


Eccentrics, and Closed vs. Open Chain Exercises

Jill talks about the recent research, as well as where eccentrics fall into the clinical picture. She speaks about the range of load, and how differently two patients with the same diagnosis can present based on their activities.


Relevant Research


Rio et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy.Br J Sports Med. 2015 Oct;49(19):1277-83. doi: 10.1136/bjsports-2014-094386. Epub 2015 May 15.


Heinemeier et al. Radiocarbon dating reveals minimal collagen turnover in both healthy and osteoarthritic human cartilage. Science Translational Medicine06 Jul 2016: Vol. 8, Issue 346, pp. 346


Screen et al. "Dynamic tracking of tendon elongation in ultrasound imaging", Proc. SPIE7625, Medical Imaging 2010: Visualization, Image-Guided Procedures, and Modeling, 76252P (February 23, 2010); doi:10.1117/12.844623;


Cook et al.  Relationship between compressive loading and ECM changes in tendons.Muscles Ligaments Tendons J. 2013 Jan-Mar; 3(1): 7–11. Published online 2013 May 21. doi:  10.11138/mltj/2013.3.1.007


Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009 Jun;43(6):409-16. doi: 10.1136/bjsm.2008.051193. Epub 2008 Sep 23.


Current Projects:

-The Nociceptive Driver in Tendons

-Clinical Outcomes

-In Season Management


Jill’s Advice

“Stop jumping on bandwagons!”
“Be more thoughtful, and trust your clinical reasoning.”
“Treat the person in front of you.”