L12 - LL TENDINOPATHIE

Question 1

Subjective assessment questions

Answer 1

Table

Question 2

10 reminders to remember on tendinopathy

Answer 2

REMININDER
10 truths needed to know about tendinopathy
1. Rest does not improve tendinopathy (rest does not increase tolerance of tendon to load)
2. Exercise = top treatment for tendinopathy
3. Modifying load = very important (reducing in short-term, need to be loaded progressively)
4. Exercise needs to be individualized (progressive increased in load to restore goal function)
5. Tendinopathy responds very slowly to exercise
6. Tendinopathy rarely improves long term with only passive treatments
7. Tendinopathy not considered classic inflammatory response
8. Cause of tendinopathy can be multifactorial
9. Pathology on imaging does not equal pain
10. Pathology not likely to reverse in most cases (rehab to improve pain & function not tissue healing

Question 3

Patellar tendinopathy:
- description
- progressive load assessment
- examples of ICF
- examples of exercises

Answer 3

Description
- Pain localized to inferior pole of patella
- Pain increases with knee extension activities storing & releasing energy (jumping or quick changes in
direction)
- Often in Athletes between 15-30yo that complete basketball, volleyball, jumping athletic events, tennis
& football or any sport with jumping / direction changes

Progressive load assessment
=> Pain should stay localized & increased with increase load to confirm diagnosis)
- Shallow squat
- Deep squat
- Small hop
- Big hop

Table
Table
Image

Question 4

Mid portion Achilles tendinopathy:
- description
- progressive load assessment

Answer 4

Description
- Pain localized 2-6cm proximal to Achilles tendon insertion
- Aggravated by energy storage & release exercises (jumping, running) & not normally repetitive
movements (swimming, cycling)
- Morning stiffness = hallmark sign

Progressive load assessment
- Double leg calf raises
- Single leg calf raises
- Double leg jump
- Single leg small hop
- Single leg big hop
- Big hops in row
- Forward hopping

Question 5

Gluteal tendinopathy;
- description
- aggravated by compressive loads
- assessment
- key load management
- examples of exercises

Answer 5

Description
- Pain at greater trochanter
- More common in women 49 yo
- Pain often refers down lateral thigh
- Single leg tasks often painful

Aggravated by compressive loads
- Hanging on hip in standing, relative hip adduction
- Sitting legs crossed
- Single leg task with excessive lateral pelvic tilt (hip moves into relative adduction)
- Crossing midline during running
- Sleeping on side, Bottom leg-sleeping on painful side (direct compression)
- Sleeping on side, top leg moves into. Relative adduction if it drops down

Table

Image
Image

Question 6

Proximal hamstring tendinopathy:
- description
- provoked in activities when deep hip flexion
- progressive load assessment

Answer 6

Description
- Pain localized to ischial tuberosity
- Warm-up phenomenon

Provoked in activities when deep hip flexion (compressive load):
- Squatting
- Lunging
- Sitting (especially harder surfaces)
- Painful during energy storage activities but normally with slow walking, standing or lying

Progressive load assessment
- Single leg bent knee bridge (low load)
- Long lever bridge (moderate load)
- Arabesque movement (high load)
- Single leg deadlift (high load)