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MSK 1 > Tendinopathy > Flashcards

Tendinopathy Flashcards

1
Q

Function of Tendon

A

Transmit forces from muscle to bone

Energy conservation (spring)

Protect muscle from injury

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2
Q

Tendon Composition

A

Highly organized, parallel collagen fiber bundles

fibers are oriented​ in one direction because force is mostly coming from one direction

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3
Q

what is the main type of collogen fiber found in tendons

A

type 1

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4
Q

what kind of force does type one fiber resist the best

A

Resist tensile force well

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5
Q

where do Tenocytes (tendon cells) sit

A

sit between collagen fibers

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6
Q

Tendon are good resisting what kind of force

A

tensile

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7
Q

tendons are bad at what what kind of forces

A

compression

shearing

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8
Q

what is shearing important for

A

loading - adapting to loads

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9
Q

what kind of structure​ is a tendon (elastic wise)

A

Viscoelastic structure

Response to loading (function) is dependent on magnitude AND rate of loading

The faster we load a tendon the more stiff it acts
Silly putty

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10
Q

what does load trigger in tendons

A

biological response

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11
Q

what does it mean - Tendons are metabolically active

A

Respond to changes in their loading environment

Tenocytes experience shear and compression forces during loading > remodeling

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12
Q

Overload + Inadequate Recovery leads to

A

injury

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13
Q

what is important for tendon recovery

A

time
after heavy loading tendons can take 72 hours to repair

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14
Q

what is Overuse in a tendon

A

imbalance in use and recovery

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15
Q

what does Degenerative mean

A

failed healing response

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16
Q

tendinopathy

A

Separation of collagen fibers

Increase in Type III collagen, thinner Type I collagen
III is not as strong

Greater proteoglycan (protein) and water content

Neovascularization (blood vessel ingrowth)
Accompanied by nerves (contributor to pain?)

Altered stiffness/viscoelastic properties

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17
Q

Tendinosis

A

= Imaging diagnosis of degenerated tendon

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18
Q

Clinical Presentation

A

Isolated tendon/enthesis pain

Load dependent: ↑ load = ↑ pain

(+) Palpatory tenderness

(+/-) Palpable thickening (superficial tendons)
Achilles tendon mostly

(+) Sensation of stiffness (AM, prolonged sitting)

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19
Q

Enthesis

A

Enthesis: where then tendon is attaching into the bone

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20
Q

Progression of symptoms

A

Early: Pain/stiffness after activity
Middle: Pain/stiffness at onset of activity, improves after warm-up, may return after prolonged activity (warm-up effect)
Late: Pain at rest, does not improve with warm-up

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21
Q

what is tendinopathy normally proceeded by

A

change in activity level

22
Q

Treatment for tendiopathy

A

Mechanotherapy, or tendon loading, is the best supported treatment for lower extremity tendinopathy

Activity modification is considered a core component of mechanotherapy

23
Q

Loading =

A

strengthening

24
Q

what does Mechanotherapy/tendon loading promote

A

Promotes tendon remodeling

Improved tendon function, viscoelastic properties, structure, and pain

25
Q

Tendon appears to respond most favorably (more remodeling) that is

A

Higher loads, up to a point (90% MVC better than 55% MVC)
Slower speeds/longer duration (more time under tension)
Dynamic vs static contractions

26
Q

tendons respond to different contraction types

A

Tendon does not respond differently to different contraction types

27
Q

4 phases of Tendinopathies

A

Symptom-Management and Load Reduction Phase
Recovery Phase
Rebuilding Phase
Return-to-Sport Phase

28
Q

Goals in the ​symptom mangment phase

A

Halt abusive loading
Manage symptoms and initiate loading
Establish/manage expectations
Establish baseline (outcome measures!)
Initiate training diary

29
Q

pt status in the symptom mangement phase

A

pain at rest or with ADLs

30
Q

Goals in the ​symptom mangment p​hase

A

Halt abusive loading
Manage symptoms and initiate loading
Establish/manage expectations
Establish baseline (outcome measures!)
Initiate training diary

31
Q

Treatment

A

Daily exercises
Progress loading up to 100% body weight
If highly irritable, may need to begin with isometric, aquatic therapy, or some form of bodyweight support
Begin addressing other impairments & risk factors (proximal and distal joint ROM, strength, endurance)
Interventions to reduce pain

32
Q

what si the Continued Exercise program

A

Followed the pain-monitoring model
- get to a certain level of pain with a activity then change it

this is showing that you do not need to stop working out

33
Q

what does compression do to recovery in tendiopathy

A

may delay or prolong recovery

34
Q

manage expectations

A

Tendinopathy takes longer to fully recover than many other overuse injuries

35
Q

with tendinopathy the the tendon often rupture

A

While possible, that vast majority of patients with painful tendons do not rupture

Tendon loading exercises may be protective against rupture

36
Q

what does a partial or interstitial tear mean in the MRI

A

Partial or interstitial tears are common MRI findings consistent with tendinopathy, generally not the same as a rupture – Check with physician if any concerns!

37
Q

pain with tendinopathy reecovery

A

need to tolerate some level of pain to get maximum benefit from loading exercises

38
Q

what level of pain is not really a concern

A

Transient (<24 hours) increases in pain are generally not a concern

39
Q

why are Training Diaries important

A

Help patients manage symptoms, track recovery
Assist clinician in modifying treatment/training

40
Q

what is included in training dairies

A

Loading exercises performed
Other activity
Pain in the morning, highest and lowest pain during day

41
Q

Recovery Phase Goals

A

Regain strength/endurance
Improve tendon’s tolerance to load

42
Q

Recovery Phase Patient Status

A

Pain with exercise
morning stiffness
pain when performing loading exercises

43
Q

Recovery Phase Treatment

A

Continue/progress loading exercises
If previously performing isometric exercises, progress to dynamic
Add external resistance
Increase speed
Light energy storage activities (plyometrics)
Prepare tendon for demands of sport

44
Q

Rebuilding Phase Goals

A

Progress to heavy loading
Promote energy storage ability

45
Q

Rebuilding Phase pt status

A

Tolerates the recovery phase exercises well

Possibly decreased or increased morning stiffness

46
Q

Rebuilding Phase treatment​

A

Add additional external resistance
Consider reducing loading to 3x/week
Must be heavy
Increase movement speeds of plyometric activities

47
Q

Return-to-Sport Goals

A

Return patient to full participation

Continue to improve tendon and lower extremity function

48
Q

Return-to-Sport pt status

A

Pain-free during daily activities and minimal pain during loading activities

49
Q

Return-to-Sport treatment

A

Continue to progress loading exercises
Initiate return-to-sport
Focus on previously aggravating activities (e.g. running/jumping)
Sport specific training

50
Q

loads and activities​ in recovery

A

Better to perform heavy loading/sports activities on same day with adequate time for recovery

Recovery days are critical

51
Q

does absencee of pain = full recovery

A

no

Continue HEP loading activities for at least 1 yr after symptoms resolve

MSK 1 (14 decks)

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