Week 9 - Tendinopathy, Aetiology, intervention

Question 1

Define Tendinosis

Answer 1

A degenerative mucoid condition characterized by increase ground substance and vascular tissue and an absence of inflammatory markers

Question 2

Define Tendinits

Answer 2

An inflammatory condition of the tendon

Question 3

Describes the stages involved in the pathophysiology of tendinopathies

Answer 3

1. Reactive tendinopath - tendon thickening, short term reduction in stress
2. Tendon disrepair - more matrix breakdown, growth of vessels & nerves, disrupted matrix of collagen
3. Degenerative tendinopathy - end-stage, apoptosis, disorganized matrix, little collagen, vessels

Question 4

Describes the stages involved in the pathophysiology of tendinopathies (3)

Answer 4

1. Reactive tendinopath - tendon thickening, short term reduction in stress
2. Tendon disrepair - more matrix breakdown, growth of vessels & nerves, disrupted matrix of collagen
3. Degenerative tendinopathy - end-stage, apoptosis, disorganized matrix, little collagen, vessels

Question 5

Describe the physiotherapy Mx for different stages of tendinopathy (2)

Answer 5

1. stages 1-2 - load Mx (reduced frequency and intensity of tendon load)
2. stages 2-3 - exercise with eccentric component, extracecorporeal shock wave therapy, frictions, ultrasound

Question 6

Describe important elements of load management?

Answer 6

• good clinical reasoning

- identify factors increase tendon load and intervene (biomechanics, activity)

Question 7

What are the effects of exercise (eccentric) for tendinopathies

Answer 7

1. Increased collagen production
2. improved structure
3. Reduce tendon vessels
4. Reduce pain (usually 4-6 weeks)

Question 8

List the tendinopathies of the foot and ankle (3)

Answer 8

TEA

1. Achilles tendiopathy
2. Extensor tendinopathy
3. Tibialis posterior

Question 9

What are the clinical findings of Achilles tendinopathy? (5)

Answer 9

• common runners or sports involving running, jumping
• localized pain
• Tenderness/thickening of mid
• occasionally crepitus or nodules
• Pain on heel rise test

Question 10

List the risk factors for achilles tendinopathy (7)

Answer 10

1. Excessive training or sudden increase
2. change of surface/footwear
3. short gastric/soleus complex
4. weak plantar flexors
5. excessive pronation (esp. medial tendon)
6. other foot impairments
7. Proximal weakness

Question 11

What is the Mx for achilles tendinopathy? (4)

Answer 11

1. relative rest
2. Heel lift insert may offload
3. local EPA and soft tissue therapy
4. Address potential causative factors found in Hx and P.E. (gastric length test, training load, pronation, hip strength, mobility)