Tendinopathies Flashcards
(28 cards)
What is a tendinopathy
it is a failed healing response of the tendon, associated with overuse in and around tendons
Definitions: tendinopathy, tendonitis, tendinosis
- General term that describes tendon degeneration
- refers to a painful tendon with histological signs of inflammation within the tenon
- is a localised intrinsic degeneration of unknown aetiology, usually characterised by localised swollen tendon nodes
Load types of tendinopathy: Compressive
A tendon can be squashed against a bone (e.g. proximal hamstring tendon against ischial tuberosity)
Load types of tendinopathy: shear and friction
movement of the tendon sheath on the tendon can cause sheath irritation, e.g. AT sheath moves with repeated DF/PF
Load types of tendinopathy: tensile
store and release energy like a a spring for power
Load types of tendinopathy: combination
A combination of compressive, tensile and shear/friction.
e.g. hockey platers running in hip flex have a combination of loads on their proximal hams tendon
first stage of tendinopathy continuum: Reactive tendinopathy
Non-inflammatory proliferative response in cell matrix. Due to compressive or tensile overload.
Cell changes shape-> more cytoplasmic organelles=increase protein function,
collagen integrity maintained, short-term adaptations- thickens the tendon to reduce stress and increase stiffness, the potential to revert back to normal tendon
second stage of tendinopathy continuum- Tendon disrepair
Chronic overload of RT.
Increased protein production- separation of collagen and disorganisation within cell matrix
great breakdown physiologically
Visible on MRI & US
May be increase vascularity and neural ingrowth in tendon
Reversibility possible with correct load and management
third stage of tendinopathy continuum- Degenerative tendinopathy
Areas of cell death due to apoptosis, trauma, tenocyte exhaustion
Large areas of matrix-disordered and vessels, matrix breakdown and little collagen
little capacity for reversibility
focal swelling and pain
high risk of rupture
clinically this is present in older individuals with ongoing problems with tendinopathy or younger individuals who have continued to overload
fourth stage of tendinopathy continuum- reactive on degnerative
hybrid of reactive and degenerative pathology
Structually (normal) part of the tend may drift in and out reactive phase
degenerative portion: unable to transmit tensile load
manage as a reactive tendon
what does the tendinopathy continuum mean clinically
Interventions should be tailored to the stage of pathology
exercise and load management fundamental to management
if correct stage not identified= symptoms may get worse
clinical presentations of tendinopathies: reactive
rapid onset, load substantially exceed previous exposure, easily aggravated by exercise and slow to settle
Painful and less common
clinical presentations of tendinopathies: reactive on degenerative
old adult (50-60)
past history of load related excaerbation
onset after overload
variable swelling
less irritable
painful and common
clinical presentations of tendinopathies: degenerative
older (30-60)
long history of minimal symptoms
variable swelling and lumps/bumps
unloading strategies
Not painful
concepts to consider with tendinoapathies
tendon don’t like compression or too much stretch-shortening cycles
tendons are highly responsive to mechanical loading
chronic, habitual tendon loading needed for adaptations
Effective training program should apply high loading intensity over long duration (>12/52)
Treatment: education
pain doesnt= harm
restore the balance between load and tissue capacity
important for compliance
kinesiophobia
manage expectations
slow to settle but quick to aggravate
Patient advise- RC tendinoapthy
avoid excessive, unaccustomed activity above shoulder height, take regular breaks from repetitive shoulder movement, pillow under arm and behind patient to prevent them rolling on that side at night
Patient advise- Tennis elbow
when gripping/lifting try and keep palm facing upwards
modify movement/activities that bring on pain
Patient advise- hamstring
avoid excessive hip flexion
avoid repeated stretching of hamstring
Patient advise- gluteal
avoid sitting with legs crossed, avoid standing with weight on one leg, avoid laying on it at night
sleep position advise- duvet folded over under patient, pillow between leg
Patient advise- patella
avoid excessive running or jumping movements intially, initially reduce load on the knee in flexed position (squat)
Patient advise- achilles
In insertional: avoid excessive DF to prevent compressive load
Avoid plyometric movements to reduce SSC/Tensile load, but continue running at a tolerable level
Put more weight through heel so not using PF
Orthotics- limited benefit however AFO can be useful in longitudinal tears in early phases of rehab
pain management
Reduced motor responses, more severe in reactive phase, manage the load on the tendon- avoid compressive load i.e. stretching, cut out activities involving SSC
anti-inflammatory to regulate tenocyte activity
isometric exercise
treatment: isometrics
5X45 sec hold with 1 min rest
significant reduction in acute pain 45 mins as compared with isotonic
well tolerated- can be tailored to patients preferred ROM
Useful for reactive tendons
