Combining Concepts Of Clinical Reasoning Flashcards
Why does tendinopathy occur and what are the structural changes that occur with it?
There is an imbalance in wear and repair processes leading to a loss of tendon homeostasis. An active degenerative process occurs involving some inflammatory processes.
1- Alterations to tendon cell populations, increased tenocytes- increases tenocyte metabolism, increased immature tenocytes, increased rate of apoptosis, immuno active cells
2- Disorganisation of collagen- there is a reduction in type 1 collagen, an increase in type 3 collagen, it is like Rope- string
3. Ground substance changes - PG (Protioglycan) GAG (Glucaminoglycans) the content alters which leads to increased water and chemical alterations occur. The increased water makes them hydrophilic, The water then accumulates in them and rips as the structure degrades
4. Neovascularization- influx of blood vessels onto the anterior and mid surface, this is involved with various nerve fibres growing into the tendon
What is the normal pain mechanism?
Nocioceptive- normal pain mechanism
Neurogenic - pins and needles- numbness and tone
Nocioplastic- chronic nocioceptive pain that has been plastically changed- can have a biopyschosocial aspect which causes widespread hyperalgesia (increased pain response from a small pain)
Hyperalodinia (any sensitisation causes a massive pain response)
What is creep?
Uncrymping of crymped collagen fibres. Transient increase in muscle length- prevents elastic recoil of tissue back to the tissues original size.
Hysteresis I’m the tissue helps reduce tissue stiffness, creates heat and restores the tissue normal chemical response to loading.
What are the principles of mechanotherapy?
Tissue loading - to strengthen tendons and ligaments (strength training) and to strengthen joints (weight bearing)
Stimulates cellular response as osteoblasts build bone and osteoclasts break bone down
Tissue adaptation
Improved tissue structures
Maintains homeostasis -maintains body ranges
