Lecture 16 - Tendinopathy Flashcards
Define Tendinosis vs Tendinitis
Tendinosis = a degenerative mucoid condition characterized by an increase in ground substance and vascualar tissue and an absence of inflammatory markers
Tendinitis = an inflammatory condition of the tendon with specific inflammatory markers
What are the 3 stages of tendon pathology
1) Reactive Tendinopathy - actue tensile stress of compressive overload, increase collagen, increase PS, increase ECM, proteoglycans, tendon thickening
2) Tendon Dysrepair = greater matrix breakdown, increased production of above, collagen separation and disruption of matrix, matrix non-linear
3) Degenerative Tendinopathy = matrix and cell changes progress, cell death/necrosis, disorganized matrix
How do you manage stage 1 and 2 (early) tendinopathy
encourage tendon adaptation to change load
load management
reduction in frequency and intensity of load
how do you manage stage 2 (late) and 3 tendinopathy
stimulate cell activity, protein production, restructure matrix
ecc exercise, Electric therapy, friction, US
How does ECC exercise help tendinopathies
increases collagen
improve tendon structure
reduce tendon vessels
reduces pain
What are the 2 theories for exercise programs for tendinopathy, describe each
Alfredson - patell and achilles, 12/52, ECC only, x3 per day, 3 sets x15, slow, progress when pain free
Curwin and Stanish: patella, 6/52, ecc and conc, x1 per day, based on speed - slow, med, fast, ice/stretch, add 10% BW every weak
Describe and Achilles Tendinopathy
occurs due to cummulative loading and microtrauma
pronation/supination leads to problems with transmission of forces
common in runners/sports with running and jumping
pain on heel rise test
often ensethopathy
What are the risk factors for an achilles tendinopathy
excessive training, change in footwear, short gastrocs/soleus complex, weak plantar flexors, excessive pronation
What are some managment techniques for an achilles tendinopathy
rest, heel lift, grastroc length, ecc exercise protocol
Describe a tib post tendinopathy
excessive rearfoot pronation in stance phase
pain near mall or navicular insert
positive IMT inversion
rest, taping, orthoses, motor control
Describe Patellar tendinopathy
inferior pole of patella
jumping activities and stairs
risk factors: weight, leg length, quads strength,
extension will cause most discomfort
less pain on passive ext
IMT knee ext pain ++
taping, retrain quads, stretch, strengthen, control
Describe Rotator Cuff tendinopathy
most common in supraspinatus pain in overhead activites night pain tenderness or supraspinatus tendon abduction painful arc 120-60 PMT - positive impingement test
Management: part 1) settle symptoms - ice rest
Part 2 ) correct abnormalities - GH instability, muscle weakness, tightness,
strengthening: ER, post capsule stretch
Describe a lateral elbow tendinopathy
most common in extensor carpi radialis brevis
insidious onset
gripping and wrist ext sports
IMT: wrist Ext ++, resisted middle finger +,
Interventions: pain management - ice rest
improve grip strenghtm and coordination of upper limb/wrist
ECC exercises, coordination of forearm, flexibility,
US,
Manual therapy, bracing/taping
