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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
Tendon appears to respond most favorably (more remodeling) that is
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
tendons respond to different contraction types
Tendon does not respond differently to different contraction types
27
4 phases of Tendinopathies
Symptom-Management and Load Reduction Phase Recovery Phase Rebuilding Phase Return-to-Sport Phase
28
Goals in the ​symptom mangment phase
Halt abusive loading Manage symptoms and initiate loading Establish/manage expectations Establish baseline (outcome measures!) Initiate training diary
29
pt status in the symptom mangement phase
pain at rest or with ADLs
30
Goals in the ​symptom mangment p​hase
Halt abusive loading Manage symptoms and initiate loading Establish/manage expectations Establish baseline (outcome measures!) Initiate training diary
31
Treatment
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
what si the Continued Exercise program
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
what does compression do to recovery in tendiopathy
may delay or prolong recovery
34
manage expectations
Tendinopathy takes longer to fully recover than many other overuse injuries
35
with tendinopathy the the tendon often rupture
While possible, that vast majority of patients with painful tendons do not rupture Tendon loading exercises may be protective against rupture
36
what does a partial or interstitial tear mean in the MRI
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
pain with tendinopathy reecovery
need to tolerate some level of pain to get maximum benefit from loading exercises
38
what level of pain is not really a concern
Transient (<24 hours) increases in pain are generally not a concern
39
why are Training Diaries important
Help patients manage symptoms, track recovery Assist clinician in modifying treatment/training
40
what is included in training dairies
Loading exercises performed Other activity Pain in the morning, highest and lowest pain during day
41
Recovery Phase Goals
Regain strength/endurance Improve tendon’s tolerance to load
42
Recovery Phase Patient Status
Pain with exercise morning stiffness pain when performing loading exercises
43
Recovery Phase Treatment
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
Rebuilding Phase Goals
Progress to heavy loading Promote energy storage ability
45
Rebuilding Phase pt status
Tolerates the recovery phase exercises well Possibly decreased or increased morning stiffness
46
Rebuilding Phase treatment​
Add additional external resistance Consider reducing loading to 3x/week Must be heavy Increase movement speeds of plyometric activities
47
Return-to-Sport Goals
Return patient to full participation Continue to improve tendon and lower extremity function
48
Return-to-Sport pt status
Pain-free during daily activities and minimal pain during loading activities
49
Return-to-Sport treatment
Continue to progress loading exercises Initiate return-to-sport Focus on previously aggravating activities (e.g. running/jumping) Sport specific training
50
loads and activities​ in recovery
Better to perform heavy loading/sports activities on same day with adequate time for recovery Recovery days are critical
51
does absencee of pain = full recovery
no Continue HEP loading activities for at least 1 yr after symptoms resolve

MSK 1 (14 decks)

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