Lecture 7 - Chronic overuse injuries Flashcards
Define insidious onset injuries
Come on overtime -> no specific MOI
Predisposing factor
Time frame for acute injuries
7-10 days
Sub-acute conditions time frame
10 days - 7 weeks
Chronic time frame
7+ weeks
Acute on chronic, what happens?
Chronic injury is typically re-injured
Generic term that describes an injury to a tendon
Tendinopathies
Tendinopathies were traditionally called ____
Tendinitis
T of F: recent research suggests little to no inflammation present in tendon exposed to overuse
TRUE
Treatment of tendinopathy has been aimed at controlling _____ + give examples of strategies
Inflammation
ex: Modalities, NSAIDs, corticosteroids
Difference between tendinitis and tendinosis
Tendinosis is a degeneration of tendon (chronic)
Tendinitis is an inflammation of tendon from micro tears
Inflammation of the tendon and results from micro tears of the tendon when the musculotendinous unit is acutely overloaded with a tensile force that is to heavy or very sudden
Tendinitis
Degeneration of the tendon’s collagen from chronic overuse
Tendinosis
Histopathological changes in tendinopathies include (3)
- Degeneration (tendinosis) and disorganization of fibers
- Increased cellularity
- Minimal inflammation
Macroscopic changes in tendinopathies include (3)
- Tendon thickening
- Loss of mechanical properties
- PAIN
Stage 1 tendinopathy
Marked by pain after activity
Stage 2 tendinopathy
Pain during activity that does not restrict performance
Stage 3 tendinopathy
Pain during activity that restricts performance
Stage 4 tendinopathy
Chronic, unremitted pain even at rest
Jumper’s knee
Patellar tendinitis
Hip flexors tendinitis affects what 2 muscles?
Rectus femoris and psoas major
Golfer’s elbow
Medial epicondylitis
Tennis elbow
Lateral epicondylitis
Medial tibial stress syndrome affects what muscle?
Tibialis posterior
Intrinsic factors that provoke tendinopathies (7)
- Flexibility
- Weaknesses
- Body mechanics
- Nutrition
- Joint laxity
- Age
- Overweight
Extrinsic factors that provoke tendinopathies (5)
- Repetitive forces on the tendon
- Occupation
- Improper conditioning
- Changes in training schedule
- Technical errors
See slide 11
Reactive tendinopathy graph
Same rehabilitations for tendinopathies as for strains, sprains, contusions, etc.
TRUE
Initial goals of early rehab in tendinopathies
Decrease pain
Guide inflammation
Fix the cause of the problem
When will patient typically come and seek treatment?
When the pain affects their performance
Which type of strengthening can begin early in rehab?
Eccentrics
Tendons have ___ vascular supply compared to muscle and ligaments
Poor
Which part of the tendon has a better vascular supply?
Paratendon (tendon sheath surrounding tendon)
When is there more tension in the muscle?
- When the muscle is shortening
- When the muscle is lengthening
Lengthening
Benefits of eccentric training
Stimulates collagen production
Improves collagen alignment
Stimulates collagen cross link formation
Parameters for eccentric training
2-7x/week for 6-12 weeks
3 x 15 with 30 sec rest
Typically day off in between
Pain allowed with eccentric training
4-5/10 - discomfort
___ load if discomfort decreases
Increase
Provides temporary pain relief but do not have long term benefits
Corticosteroids
Good option for calcific tendinopathy of the shoulder
Electric shock wave therapy
Last option of treatment for tendinopathies
Surgical debridement
2 steps of rehabilitation of insidious onset injuries
- Find out the cause of the problem
- Correct the dysfunctions
What not to do with rehab of tendinopathies
DO NOT CHASE THE PAIN
