Lecture 7 - Chronic overuse injuries

Question 1

Define insidious onset injuries

Answer 1

Come on overtime -> no specific MOI
Predisposing factor

Question 2

Time frame for acute injuries

Answer 2

7-10 days

Question 3

Sub-acute conditions time frame

Answer 3

10 days - 7 weeks

Question 4

Chronic time frame

Answer 4

7+ weeks

Question 5

Acute on chronic, what happens?

Answer 5

Chronic injury is typically re-injured

Question 6

Generic term that describes an injury to a tendon

Answer 6

Tendinopathies

Question 7

Tendinopathies were traditionally called ____

Answer 7

Tendinitis

Question 8

T of F: recent research suggests little to no inflammation present in tendon exposed to overuse

Answer 8

TRUE

Question 9

Treatment of tendinopathy has been aimed at controlling _____ + give examples of strategies

Answer 9

Inflammation
ex: Modalities, NSAIDs, corticosteroids

Question 10

Difference between tendinitis and tendinosis

Answer 10

Tendinosis is a degeneration of tendon (chronic)
Tendinitis is an inflammation of tendon from micro tears

Question 11

Inflammation of the tendon and results from micro tears of the tendon when the musculotendinous unit is acutely overloaded with a tensile force that is to heavy or very sudden

Answer 11

Tendinitis

Question 12

Degeneration of the tendon’s collagen from chronic overuse

Answer 12

Tendinosis

Question 13

Histopathological changes in tendinopathies include (3)

Answer 13

• Degeneration (tendinosis) and disorganization of fibers
• Increased cellularity
• Minimal inflammation

Question 14

Macroscopic changes in tendinopathies include (3)

Answer 14

• Tendon thickening
• Loss of mechanical properties
• PAIN

Question 15

Stage 1 tendinopathy

Answer 15

Marked by pain after activity

Question 16

Stage 2 tendinopathy

Answer 16

Pain during activity that does not restrict performance

Question 17

Stage 3 tendinopathy

Answer 17

Pain during activity that restricts performance

Question 18

Stage 4 tendinopathy

Answer 18

Chronic, unremitted pain even at rest

Question 19

Jumper’s knee

Answer 19

Patellar tendinitis

Question 20

Hip flexors tendinitis affects what 2 muscles?

Answer 20

Rectus femoris and psoas major

Question 21

Golfer’s elbow

Answer 21

Medial epicondylitis

Question 22

Tennis elbow

Answer 22

Lateral epicondylitis

Question 23

Medial tibial stress syndrome affects what muscle?

Answer 23

Tibialis posterior

Question 24

Intrinsic factors that provoke tendinopathies (7)

Answer 24

• Flexibility
• Weaknesses
• Body mechanics
• Nutrition
• Joint laxity
• Age
• Overweight

Question 25

Extrinsic factors that provoke tendinopathies (5)

Answer 25

- Repetitive forces on the tendon - Occupation - Improper conditioning - Changes in training schedule - Technical errors

Question 26

See slide 11

Answer 26

Reactive tendinopathy graph

Question 27

Same rehabilitations for tendinopathies as for strains, sprains, contusions, etc.

Answer 27

TRUE

Question 28

Initial goals of early rehab in tendinopathies

Answer 28

Decrease pain Guide inflammation Fix the cause of the problem

Question 29

When will patient typically come and seek treatment?

Answer 29

When the pain affects their performance

Question 30

Which type of strengthening can begin early in rehab?

Answer 30

Eccentrics

Question 31

Tendons have ___ vascular supply compared to muscle and ligaments

Answer 31

Poor

Question 32

Which part of the tendon has a better vascular supply?

Answer 32

Paratendon (tendon sheath surrounding tendon)

Question 33

When is there more tension in the muscle? - When the muscle is shortening - When the muscle is lengthening

Answer 33

Lengthening

Question 34

Benefits of eccentric training

Answer 34

Stimulates collagen production Improves collagen alignment Stimulates collagen cross link formation

Question 35

Parameters for eccentric training

Answer 35

2-7x/week for 6-12 weeks 3 x 15 with 30 sec rest Typically day off in between

Question 36

Pain allowed with eccentric training

Answer 36

4-5/10 - discomfort

Question 37

___ load if discomfort decreases

Answer 37

Increase

Question 38

Provides temporary pain relief but do not have long term benefits

Answer 38

Corticosteroids

Question 39

Good option for calcific tendinopathy of the shoulder

Answer 39

Electric shock wave therapy

Question 40

Last option of treatment for tendinopathies

Answer 40

Surgical debridement

Question 41

2 steps of rehabilitation of insidious onset injuries

Answer 41

1. Find out the cause of the problem 2. Correct the dysfunctions

Question 42

What not to do with rehab of tendinopathies

Answer 42

DO NOT CHASE THE PAIN