Therapeutic exercise approach for tendinopathy Flashcards
week 3 (45 cards)
what are tendons and what do they do?
noncontractile soft tissue
- primarily type I collagen
- some elastic
- serves as an attachment point from muscle to bone
transmit (muscle) forces t o(skeletal) levers to facilitate movement (store and release energy)
What properties comprise healthy tendons?
- stiffer than muscle
- has greater tensile strength than muscle
- can withstand large loads w/ minimal deformation
these properiteis enable tendons to transmit muscle forces efficiently while minimizing energy loss from tendon strain
when is strain a bad thing?
during activities requiring efficient force transmission i.e. jumping (want tendon stiff)
what is tendon stiffness?
isn’t: hypomobility your reduced ROM
IS: resistance to deformation strain under load
how we minimize energy loss is stiff tendons
what is tendon elasticity?
the ability of your spring to recoil ( and a stiff tendon recoils faster)
when is strain a “good” thing?
Muscle Fiber Damage:
When you lift weights or perform other physically strenuous activities, muscle fibers tear slightly.
Repair and Growth:
The body then repairs these microscopic tears, and in doing so, the muscle fibers grow back stronger and larger than before, leading to increased muscle mass and strength
What is tendinopathy?
a general term that refers to tendon (microtraumatic) injury affected by mecnanimcal loading
- pain and dysfunction in the tendon
tendinopathy is most reported in what areas?
- achillies
- patellar
- lateral elbow
- rotator cuff
- hip
can affect any muscle-tendon unit in the body but most commonly seen in these places
pathophysiology of tendinopathy
pathogenesis is unclear but
- tendinopathy is commonly preceded by a change in activity
- too rapid a progression without adequate recovery
- attempted return to PLOF following forced relative rest
- renders tendon susceptible to pathological changes and degradation
prior level of function = PLOF
load accumulation disease
tendinopathy is now widely considered to be degenerative and NOT ?
a classic inflammatory response
- why we say tendinopathy now vs. tendinitis
tendinopathy can be classified across a continuum consisting of what 3 stages
- reactive tendinopathy
- tendon disrepair
- degenerative tendinopathy
How does reactive tendinopathy occur?
what is going on at the cellular matrix and collagen level?
typically results from acute bout of overload
- changes in the cellular matrix
- collagen integrity is largely maintained
- potential to normalize
changes only to cellular matrix - collagen still good (important bc there is potential for reversability)
disrepair tendinopathy?
cellular matrix and collagen?
- chronically overloaded tendon
- changes in the cellular AND collagen matrix
- collagen becomes disorganized
- some reversibility possible
changes to both cellular matrix and collagen - same as degenerative tendinopathy
degenerative tendinopathy?
cellular matrix and collagen?
- chronically overloaded tendon
- changes in the cellular AND collagen matrix
- progressive
disorganization, breakdown, and less collagen - little if any capcaity for reversibility
what will be occuring at the cellular level in a tendinopathy?
- rounded fibroblasts unevely distributed throughout the tissue
- increased ground substance
- capillary ingrowth
- disorganzied type I and III collagen fibrils
a healthy tendon remains even in the ________ or __________ tendon
“disrepair” or “ degenerative”
tendinopathy management considerations in brief
- DOES NOT improve with absolute rest (relative rest is better)
- modifying load is imporatnt to reduce tendon pain
- exercise is the most evidence based treatment
because tendon pain is directly liked to ________ _______, the body learns how to avoid load to the tendon
tendon loading
since the body is good at compenstating and avoiding loading the tendon - tendinopahties are very often accompained by?
- muscle dysfunction (reduced muscle capacity, atrophy)
- kinetic chain dysfunction
why is therapeutic exericse good for tendinopathies?
- modulate pain
- restore structural integrity in the unhealthy tendon
no go for degenerative, have low expectations for disrepair - improve tendon load capacity in the halthy tendon
- optimize tendon function for performance
how does therapeutic exercise improve tendon load capacity?
think train the strain
train the strain
- in teh presence of appropriately dosed stress (load) the tissue will respond strain
- tenocytes respond to that strain
- tissue adaptation follows:
- increased collagen synthesis
- normalized collagen morphology (type, organization)
how does therapeutic exercise improve tendon function for performance?
bring the spring (plyos) - work on tendon load capacity before the performance.
train the strain then bring the spring
the brain with exercise and tendinopathies:
cortical inhibition reduces - motor excitability increases
in the presence of tendon pain, cortical inhibitoin increases and thereby reduces and or delays motor output to the dysfunctional tendon
ther ex for tendinopathy:
frequently and should include resistance training - what types?
resistance training
- isometric
- dynamic muscle contraction (eccentric)
- heavy slow resistance
at presesnt no single protocol appears to have demostracted superiority
