Tendinopathy

Question 1

Subjective assessment tendinopathy

Answer 1

• where is pain ? Very located
• what aggravates pain? Load
• Night pain ? No
• Morning stiffness? Yes, but goes away with movement
• Does pain > or < with activity ? Usually decrease but can have pain related to tendon
• Pain the day after ? Should decrease 24h after load
• Risk factor? Medication/biomech/hypercholesterolemia

Question 2

Reminder

Answer 2

• rest does not improve tendinopathy: don’t allow tendon to increase tolerance to load
• exercise is top treatment
• modifying load is very important : allow tendon to increase tolerance to load/ should be progressive
• exercise needs to be individualize
• tendinopathy responds very slowly to exercise
• tendinopathy rarely improves long term with only passive treatment
• tendinopathy is not considered a classic inflammatory response
• the cause of tendinopathy can be multifactorial
• pathology on imaging does not equal pain
• pathology is not likely to be reversed ( physio tend to target towards improvement of symptoms, rather than healing tissue)

Question 3

Patellar tendinopathy characteristics

Answer 3

• Pain localised to the inferior pole of the patella
• Pain increases with knee extension activities that store and release energy (ex. Jumping)
• Often in Athlete (15-30) : sport with jumping/ direction change

Question 4

Progression load assessment in patella tendinopathy

Answer 4

• shallow squat
• deep squat
• small hop
• big hop

Question 5

Mid portion Achilles tendinopathy characteristics

Answer 5

• pain localised 2-6cm proxi to Achilles tendon insertion
• aggravated by NRJ storage and release exercise

Question 6

Progressive load assessment for midportion Achilles tendinopathy

Answer 6

• double left calf raise
• single leg calf raise
• double leg jump
• single leg small hop
• single leg big hop
• big hops in a row
• forward hopping

Question 7

Gluteal tendinopathy characteristics

Answer 7

• pain at greater trochanter
• more common in women over 49y
• pain often refers down the mat thigh
• single leg task often painful
  !! Aggravated by compressive load ( hanging on hip in standing, sitting legs crossed, sleeping on side..)

Question 8

Gluteal tendinopathy assessment

Answer 8

• palpation
• 30 second SLS
• resisted Adduction ( abduction)
• Resisted FADER

Question 9

What does hip Adduction do to tissue

Answer 9

Hip adduction increase compressive load of the soft tissues at the greater trochanter . So sustained position of hip adduction for prolonged periods can be provocative for those with gluteal tendinopathy

Question 10

Gluteal tendinopathy management- Education

Answer 10

As hip adduction increase compressive load at GT, educate patient to avoid prolonged Adduction position such as sitting position with leg crossed, hanging on one hip standing…

Question 11

Gluteal tendinopathy management- exercise

Answer 11

• abductor isometrics
• bridging progression
• functional loading progression
• frontal plane progression

Question 12

Proximal hamstring tendinopathy

Answer 12

• pain localised to ischial tuberosity
• provoked in activities with deep hip flexion (squatting, lunging, sitting, painful during energy storage activities)

Question 13

Progressive load assessment for proximal hamstring tendinopathy

Answer 13

• single leg bent knee bridge
• long lever bridge
• Arabesque movement
• single leg deadlift

Question 14

Why testing tendinopathy with progressive load assessment?

Answer 14

To have a positive test, the pain should stay localised and increase as the load increase too