Tendinopathy Flashcards
1
Q
Describe tendinopathy
A
- Repetitive overload: structural injury to microscopic collagen fibrils
- Clinical signs: pain at tendon, swelling at tendon, decreased function to tendon
2
Q
Intrinsic risk factors for tendinopathy
A
- Systemic diseases
- Family history
- Obesity
- Age
- Limited or excessive joint mobility
- Muscle weaknesses
- Deficits in neuromuscular control
- Tendinosis & altered tendon structure
3
Q
Extrinsic risk factors for tendinopathy
A
- Overuse
- Sudden increase in activity or intensity of activity
- Initiation of new activities
- Lack of adequate recovery
- Highly repetitive movement
- Poor workplace ergonomics
- Medications: Fluoroquinolones and Hormone replacement therapy
- Statins
4
Q
Describe the prostaglandin mediated inflammation of an acute soft tissue injury
A
- Vasodilation
- Vascular permeability
- Pain receptors become sensitized
- Immune response
- Vascularity good
5
Q
Describe the healing of a tendinopathy
A
- Heal by “cell to cell’ communication: tendon cells are mechanoresponsive
- Cytokines response to overload or underload: stimulate matrix remodeling (degradatin or synthesis)
- Tenocytes maintain the extracellular matrix & are influenced by tendon load & biochemical stimulus (respond to cytokines)
- Vascularity bad
6
Q
Describe mechanotransduction
A
- Refers to the process by which the body converts mechanical loading into cellular responses
- Mechanical trigger or catalyst
- Communication throughout a tissue to distribute the loading message
- Response at the cellular level to effect the response
7
Q
Describe mechanotherapy
A
- Therapeutic exercise is prescribed to promote the repair or remodeling of injured tissue
8
Q
Epidemiology of tendinopathy
A
- More common than OA
- LE > UE
- Athletes > general population
- 18-65 y/o (women more common than men)
- <18 y/o (boys more common than girls)
9
Q
Typical history for a tendinopathy
A
- Early: stiffness, gets better with activity, worse at cool down
- Injury history, especially if “deloaded”
- Intrinsic/extrinsic factors, family factors
- Causes: overuse and/or overload
10
Q
Examination and imaging for proper diagnosis for tendinopathy
A
- Focal pain, not diffuse, possible swelling, but not inflammatory
- Compressive or tensile load reproduces pain, goes away when load is removed
- Imaging: poor correlation between structure & pain, limited role
11
Q
Treatment goals for tendinopathy
A
- Education (process will take a long time)
- Reduce symptoms and promote tendon healing
- Improve capacity of the tendon & muscle to manage load
- Improve patient function
12
Q
Treatment techniques for tendinopathy
A
- Passive: pharmacy, injection, extracorporeal shockwave therapy, therapeutic ultrasonography, low level laser
- Active: tendon loading exercise, education, load management
13
Q
Exercise based strategies for tendinopathy
A
- Tendon loading exercises
- Eccentrics
- Isometrics
- Heavy Slow Resistance (HSR)
- Progressive individualized strengthening program
- Key concept the patient needs to be aware of: exercise duration >12 wks likely 1 yr for results and tendons take 6-12 months to fully heal
14
Q
Foundations of exercise programming do not change with tendinopathy which includes
A
- Restore motion: manual therapy including mobilization & manipulation
- Restore motor control & coordination
- Restore tissue tolerance (muscle performance): train all muscles for vascularity except the impaired tendon
- Maintain/improve conditioning
- Activity modification: stay active 7 address equipment and/or biomechanical concerns
15
Q
What should you NOT do for tendinopathy
A
- RICE
- Static stretching: dynamic stretching & neurodynamics are OK
- Immobilization
- Heat: no therapeutic ultrasound
- Continue to overuse tendon
- Patient factors: avoid smoking, antibiotics, & NSAIDs
16
Q
Equipment considerations for tendinopathy
A
- Free weights/barbells/pulley/weight machines & single limb stance work
- NO bands, isokinetic equipment, dynamic surface, & bilateral work
17
Q
Loading considerations for tendinopathy
A
- 55% of 1RM up to 90% 1RM
- Must be heavy
- Use pain as a guide as there may be some pain but it should not greatly impact motor control
18
Q
Rep considerations for tendinopathy
A
- > 9 reps: increase micro trauma, work past creep phase into plastic phase, goal to increase load, not reps
- 3x15 vs 1x10
- Goal 5-10 minutes of stress, 6 hours of rest, AM and PM sessions
19
Q
Time principle for tendinopathy
A
- Time: 5-10 minutes of stress (use timer)
- Frequency: 6 hours minimum b/w sets
- Speed: musculotedinous = eccentric, slow (>7 sec), 1 set of 10-15 reps; tendon osseous = isometric, 30 seconds, 4 reps, 2 minute rest
- Load: heavy as pain free & coordinated (55-90% 1RM)
20
Q
Which tendons are eccentric based versus isometric based
A
- Eccentric based = quadriceps & Achilles tendons
- Isometric based = patellar & supraspinatus tendon
