Tendinopathy

Question 1

Structure

Answer 1

Ordered collagen network

• Few spindle-shaped tenocytes
• Minimal protoglycans (decorin and biglycan)
• Predominantly Type I collagen
• Ordered collagen network
• Minimal vascularity

Question 2

Loading

Answer 2

‘…overuse, maluse, unacustomed use, non- traumatic injury…’

Question 3

Exercise Related Tissue Maladaptation:

Answer 3

Exercise ~ workload
e.g., = time (of exercise) X RPE
Chronic workload = 4 week average [fitness effect]
Acute workload = 1 week average [fatigue effect]
Acute to chronic ratio = Acute / Chronic
* 10% increments is what works

Question 4

Pathology

Answer 4

Cell proliferation, cells rounder, more endoplasmic reticulum
Proteoglycan: Biglycan and aggrecan increase, decorin same, 3 times more than tensile tissue, 25x metabolic rate
Substantial increase in Type III collagen, some Type II
Disorganised collagen network
Abundant but variable vascularity

Question 5

Local tendon pathology

Answer 5

• angiofibroblastic hyperplasia
• hypercellularity
• collagen fibrils disarray
• increased matrix protein
• neovascularisation
• get more cells and become
  rounder, lay down ty. 3 collagen,
  mechanical spacing btwn collagen fibres>
  start to break down

Question 6

Clinical assessment: diagnosis

Answer 6

Reactive and degenerative

- Pain, function, pathology

Question 7

Relationship between structure, function and pain.

Answer 7

poor function: unloaded tendon with low capacity, suspectible to overload resulting in pathology and pain
Pain: imaging normal painful tendon, rare, differential diagnosis
patholgy: degenerative non painful tendon with good
function, can rupture

poor function+pathology: degenerative non painful tendon with poor function, can rupture

poor function+pathology+pain: pathology and pain with loss of function (reactive, reactive on degenerative)

Question 8

Clinical assessment: diagnosis

Answer 8

Generic features:
• Localised area of pain at the tendon – with no referral
• Note if it is insertional/enthesis or mid-tendon
• Palpation (± loading) of the local area
• Loading (pain onset, count repss, pain level (/10)):
– high load – slow and then faster (e.g., rise on toes, hopping)

Question 9

Clinical assessment:

functional

Answer 9

Functional capacity
Movement competency
Motor control

Question 10

Rehabilitation: physio

Answer 10

• Advice and education
– what is critical and what is not
• Outcome measures to assess rehab effects
• Local tendon exercise
• Muscle strengthening exercise
• Functional retraining:
– Movement competency – motor control…

Question 11

Rehabilitation: physio

Advice and education

Answer 11

• Positions of compression of tendon/enthesis
• Rest – catabolic
• Loading (rehab, boom/bust cycles)
• Other related issues (e.g., BMI, Diabetes, etc)
• Injections (and other invasive treatments?)

Question 12

Rehabilitation: outcome measures

Answer 12

• Pain and disability
– Tendon specific (eg, PRTEE, VISA-A,P,G etc) – Generic to limb or region (eg, LEFS, DASH)
• Measure loading (reps, pain level)

Question 13

Rehab - exercise

Answer 13

start with isometric exercises - about 30-40 second holds

- progress to isotonic exersises

Question 14

Tendinopathy:

Answer 14

Pathology: impairments in motor system & associated treatment strategies