PT

Question 1

Ticket muscle

Answer 1

quads and GMa

Question 2

Who does it generally affect?

Answer 2

young, active people involved in high spring function sports

Question 3

Presentation of PT

Answer 3

• tendon feels stiff/sore when loaded after rest
• improves with gentle mvt
• tendon pain can increase with continued loading
• can improve with rest
• tendon often gets worse 2-24hr period following load

Question 4

Risk factors

Answer 4

• male gender
• participation in high spring loading sport
• excessive loading (a workload spike)
• quads, hip extensor and hamstring weakness
• reduced dorsiflexion

Question 5

Physical features

Answer 5

• palp of patellar tendon, inferior pole and tendon mid-belly
• isometric loading test
• royal london test
• spring function

Question 6

Red flag

Answer 6

Osgood slatters - pain over tibial tuberosity. seen in teenagers

Question 7

Initial Management

Answer 7

optimising load, isometric loading, quads massage, optimise strength and conditioning

Question 8

Rehab

Answer 8

1. restore quads strength
2. restore GMa and HS strength
3. strengthening other impaired muscles
4. restore functional strength
5. restore spring function
6. load management

Question 9

Pathophysiology of tendinopathy - components

Answer 9

1. stress shield
2. normal tendon
3. reactive tendinopathy
4. tendon dysrepair
5. degenerative tendinopathy

Question 10

Draw graph describing tendinopathy pathophysiology

Answer 10

See workbook

Question 11

Stage 1 of pathophysiology of tendinopathy

Answer 11

• normal load required for tendon to remain healthy -
  there are adaptations to optimise load and strengthen
• decreased load results in more susceptible tendon -
  stress shielding, load can be normal (or excessive) when
  combined with individual risk factors can result in
  reactive tendinopathy
• increase/decrease load drives tendon back and forward
  across continuum. regular doses of slightly excessive
  tendon load results in stronger tendon. severe/chronic
  excessive load results in tissue breakdown and
  pathology

Question 12

Stage 2 of pathophysiology of tendinopathy: reactive

Answer 12

• non inflammatory, proliferate response in the cell/matrix
  due acute tensile/compressive overload
• results in short term adaptive thickening/stiffening so
  tendon can cope with loads (decrease stress)
• here the tendon can still revert to normal by overload
  decreasing or time between loading decreasing

Question 13

Stage 3 of pathophysiology of tendinopathy: tendon dysrepair

Answer 13

• similar to reactive stage, attempts tendon repair/healing

but greater matrix breakdown

Question 14

Stage 4 of pathophysiology of tendinopathy: degenerative tendinopathy

Answer 14

• microtrauma (disruption collagen, cell death and
  neovascularisation) leading failed healing and structural
  changes
• now incapable transmitting mechanical load - decreased
  tendon stiffness and tensile strength

Question 15

Spring function - role of hip knee ankle

Answer 15

spring function is generated by summation of hip, knee and ankle force/spring behaviour.; hip functions as the force producer of the spring; knee modulates spring function during high spring tasks, and the ankle during low spring tasks.

Question 16

Spring theory

Answer 16

The LL functions as a spring the spring mass model is used to describe this. The physical phenomenon which explains SMM is Stretch Shortening Cycle (SSC). Involved eccentric contraction, immediately followed by a concentric contraction which characterises all forms of locomotion. SSC utilises elastic storage and release to enhance efficiency of spring-function activity.

Question 17

Stiffness of spring

Answer 17

high level LL stiffness is good as its more effective and resilient. The level of stiffness can change depending on what you’re doing