lec 7 - muscle and tendon injury

Question 1

what is a tendon

Answer 1

collagen tissue that connects muscle to bone
- transfer force from muscles into skeletal system

Question 2

what is the enthesis

Answer 2

junction between a tendon and bone
- consists of fibrocartilage

Question 3

what is an umbrella term for injuries affecting the enthesis

Answer 3

enthesopathy

Question 4

what is the myotendinous junction

Answer 4

connection between tendon and muscle (where most muscle injuries occur)

Question 5

where is the weakest part of the muscle-tendon complex

Answer 5

myotendinous junction

Question 6

what does an event leading to 4% change in tendon lead to

Answer 6

plastic changes in the tendon leading to eventual injury/rupture

Question 7

what is the tendon’s adaptation to training

Answer 7

increase in CSA

Question 8

what is the ideal loading for tendons and what occurs in the tendon

Answer 8

loading every 2-3 days - protein synthesis stays elevated during this time
adapt to lower loads than muscle - higher collagen production with less load

Question 9

what causes acute tendon injuries

Answer 9

direct trauma
rupture - force through tendon is exceeding what it can handle

Question 10

are acute tendon injuries more likley to be caused by concentric or eccentric forces

Answer 10

eccentric - muscle forces can be higher in this phase of mvmt

Question 11

what is the umbrella term for tendon problems

Answer 11

tendinopathy

Question 12

what are 4 ways to manage tendinopathy

Answer 12

education
load monitoring
pain monitoring
exercise based progressive rehab program

Question 13

how does pain monitoring work for tendinopathy

Answer 13

used to identify load volume adn load types that trigger the pain
- expect to have pain during rehab but look for progress
- need to load to retain healthy tissue

Question 14

how is pain used in exercise based progressive rehab program

Answer 14

used as a marker to move up stages
- increased pain = too much at that stage

Question 15

what are the 4 stages of exercise based progressive rehab program

Answer 15

1. isometric exercises
2. isotonic and heavy slow resistance exercises
3. increases in speed and energy storage exercises
4. energy storage and release and sport specific exercises

Question 16

what are isometric exercises and what are the benefits

Answer 16

contraction without mvmt
- analgesic for tendinopathies
- good part of NMT warmup

Question 17

what are the benefits of isotonic and heavy slow resistance exercises

Answer 17

improve muscle strength and tendon stiffness

Question 18

what are the benefits of speed and energy storage exercises

Answer 18

improve eccentric mvmt and deceleration phase

Question 19

what are possible mechanisms for tendinopathies

Answer 19

• repetitive tensile or compressive loading = repetitive microtraumas
• inadequate recovery between loadings
  high loads are NOT the problem
• progression and periodisation are the most important

Question 20

what is the progression of tendinopathy symptoms

Answer 20

1. pain after exercise
2. pain at the start of an activity (don’t feel as much pain after warmup)
3. pain both during and aftrer exercise

Question 21

what are the 3 stages in the cook purdam model for tendon pathology

Answer 21

1. reactive tendinopathy
2. tendon disrepair
3. degenerative tendinopathy

Question 22

what is stage 1 - reactive tendinopathy

Answer 22

non inflammatory, structural changes, and thickening of stressed tendon area

Question 23

what is stage 2 - tendon disrepair

Answer 23

worsening tendon pathology
tendon structure becomes disorganised (more structural changes than stage 1)

Question 24

what is stage 3 - degenerative tendinopathy

Answer 24

chronic end stage of tendon injury
very hard / impossibel to be normal tissue again

Question 25

is acute rupture of a normal and healthy tendon common or rare

Answer 25

rare - only really occurs in athletes adn rec exercisers aged 30-50

Question 26

where does tendon rupture occur

Answer 26

most common = mid tendon area also at the bone tendon junction

Question 27

what is the mechanism for achilles tendon rupture

Answer 27

strong contracture of the lower leg musculature with simultaneous extension - eccentric loading of the tendon (deceleration)

Question 28

what is unique in the diagnosis for achilles tendon repair

Answer 28

reduced power in plantar flexion, gap in the tendon tissue

Question 29

why is an achilles repair casted with a heel lift

Answer 29

to let the tendon heal in the shortest position to maintain elasticity

Question 30

what are the main prevention strategies for tendon rupture

Answer 30

NMT appropriate loading (S&C) and load management

Question 31

what is the function of muscle

Answer 31

generate power

Question 32

what does muscle force do in concentric action

Answer 32

max muscle force decreases as speed of contraction increases

Question 33

what does muscle force do in eccentric contraction

Answer 33

muscle force increases with increased speed of contraction - higher risk of muscle injuries

Question 34

what are the 2 factors in muscles rapid adaptation to training

Answer 34

neural factors (1st) - increase the ability to recruit several muscle fibres at the same time muscular factors (2nd) - muscle fibres increase their CSA (hypertrophy)

Question 35

where do muscle strains usually occur

Answer 35

close to MTJ (proximal or distal) - hamstrings, quads, gastroc

Question 36

what are the symptoms of muscle strain

Answer 36

- pain on active contraction and passive stretch - reduced contraction strength - decreaed ROM and loss of function

Question 37

what is the grading system for muscle strains

Answer 37

grade 1 (mild) - few fibre injury, minimal loss of strength and function grade 2 (mod) - tissue damage, decreased ability to contract and decreased ROM grade 3 (severe) - complete tear and loss of muscle function

Question 38

what are the two types of hamstring rupture

Answer 38

type 1 - sprinting related (biceps femoris) type 2 - stretching related (semimembranosus)

Question 39

what are the stages of muscle injury healing and how do they relate to general injury healing phases

Answer 39

1. destructive phase (hemostasis and inflammation) 2. repair phase (proliferation) 3. maturation phase (remodelling)

Question 40

how to prevent hamstring strains

Answer 40

eccentric training is way more beneficial than concentric - loading is so important - no evidence that stretching helps (doesn't decrease risk)