Tendonopothy Flashcards
(25 cards)
What is the arrangement of a tendon
Densely parked parallel slightly very type one collagen bundles interspersed with tenocytes
Epimysium Perimysium Fasicle Endomysium Muscle fibre Fibril Microfibril Collagen
What is collagen in tendons held together by
Proteoglycans component
Function of collagen and proteoglycans
Collagen= pulling and stretching
Proteoglycans= compression
What is the roll of connective tissue in tendons
Allow tendons to transmit tension and slide and glide over each other
Change shape as the muscle contracts
Blood supply of a tendon
Sparse
Blood vessels originate at the Musculotendinous junction osteotendinous junction and paratendon= spread throughout Endotenon parallel to collagen
Low metabolic rate
Normal tendons
Need to be able to withstand tensile of compressive forces
They are a plastic structure capable of adapting to the loading environment adapt their structural and mechanical properties
Store energy stretch shortening cycle for propulsion
Overload of a tendon
overload results in the development of pathology and a tendon that is less capable of sustaining repeated tensile load
slow metabolic rate / slow turnover of collagen 50/100 days
So expectation of treatment needs the realistic
O2 consumption x7 lower than muscle
Strength training= improve structural integrity
Does it matter which part of the tendon you injur
Tendonopothy mid portion of Achilles
Yes depending where are you injure in the tendon is affected by different problems e.g.
Tensile problems in mid portion
Lower near insertion= compression
Stress shielding
Prolonged rest can cause a weak tendon as can cause an imbalance if enzymes and inhibitions resulting in tendon breakdown
Tendinopathy
Over use tendon injury
Common infury
Common: athletes and non-athletes
occurs when the load placed on the tendon exceeds the tendons capacity results in pain decreased exercise tolerance of the tendon impaired physical function certain tendons are more commonly affected than others
What dio patients complain about with tendinopathy
Pain
Decreased exercise tolerance
Impaired physical function
Which tendons are more susceptible to Tendinopathy
Patella tendon
Common extensor tendon of the elbow
Rotator cuff
Achillis tendon
Risk factors extrinsic
Changes in loading
Activity levels
Training errors
Recent injury
Risk factors intrinsic
Recent injuries
Age
Gender mail
Weight gain= affects circulating cytokinins It’s cellular reaction and affects tendon
Muscle power/strength
Previous lower limb tendinopathy
Altered biomechanics e.g. reduced ankle Dorsiflexion or over pronation
Process of tendonopothy
Reactive tendinopathy
Tendon disrepair or field healing
Degenerative tendonopothy
I continue model and therefore there is continuity between stages
Adding or removing load is the primary stimulus that drives a tendon forward or backwards along the continuum
What causes reactive tendionpathy
Excessive load
Reactive tendinopathy
Non-inflammatory proliferative response in cells and matrix
Increase production of protein
Activation of tenocytes= more proteoglycan is laid down
Changes to the matrix as there is an increase in bound water due to hydrophilic proteoglycans
Quicker adaptation necessary
Swelling of the time = Reduce stress per unit area by increasing cross-sectional area or allows adaptation to occur
Tendon disrepair
Attempt of tending to heal similar to reactive tendinopathy but with greater matrix breakdown
Increase in tenocytes production cellular metaplasia takes place and the cells change becoming more like chondrocytes Flat elongated sells change to rounded cells
Myofibroblasts are present and there is an overall increase in protein production
Increase Proteoglycan results in separation of collagen and further disorganisation of metrics
Increase in collagen synthesis type 1 and type 3
Increased vascularity of tendons annual increase in tissue if excessive load and continues it becomes degenerative
Degenerative tendinopathy
Extensive matrix damage and cell changes and cell necrosis
Tendon is degenerative and there were there are hardly any cells
Large areas of metrics are disorganised filled with blood vessels and nerves and growth and there are metrics breakdown products evident
Little collagen is present and the tendons are susceptible to rupture with little capacity of reversibility
Tendons have islands of degenerative pathology dispersed between normal tendon
Clinical presentation of tendon problems
Achilles
Variable depending on tendon affected on site and stage of pathology
Localised pain or swelling
Pain may develop after heavy or a customer and training or trauma
Latent pain after exercise
Pain after rest period
Pain and some stiffness on rising/use of tendon
Older versus younger patients with tendinopathy
An older patient is going to present with a thicker nodular tendon which is more likely to be degenerative whereas an athlete following injury or more likely to be reactive
Clinical presentation and management general principles
Where is the tendon pathology in relation to the continuum model of tendinopathy
Reactive tendinopathy early tendon disrepair or late tendon disrepair degenerative
Pain is not his present and doesn’t always relate to the stage of pathology
If pain is the main problem a case can be made for concentrating on reduction of pain as a valid outcome
Clinical treatment directed at changing tendon structure or pathology are considered optimal interventions
Chronic pathology changes may not be reversible but rehab may still improve pain
Clinical presentation and management based on stage of pathology and pain
Reactive tendinopathy and early tendon disrepair
Ice heel raise
Pain relief
Load management/production
Usefulness of NSAIDs and US unclear
Graded isometric muscle exercises in mid range
Once the reactive tendinopathy seems to have settled gradually progressed to strengthening and return to normal function
Gentle stretches maintain ROM
Avoid causative factors: eg weight
Graded strengthening and activity levels eccentric loading and progress to normal function
Clinical presentation and management based on stage of pathology and pain
Late tendon dsyrepair degeneration
Load reduction activity modification and pain relief e.g. isometrics are important initially
Treatment that stimulate normal activity increase protein production collagen or ground substance and restructure the tendon matrix are appropriate for this stage of tendinopathy
Graded strengthening and conditioning e.g. eccentric concentric and functional or sport specific rehab may be required endurance functional loading
