Tissue Mechanics Tendon Injury

What are some common causes of compressive force injuries to tendons

caused from something extrinsic to the tendon causing constant compressive force

how can tendon injuries develop from shear forces and friction

Overuse injury

ex IT bands, flexor halluxis tenosynovities, De Quervain’s Syndrome

describe the two broad categories of tendon damage based on load and composition

• load amount or pattern increases because of functional demands and tendon composition remains the same

  • eccentric activity

• tendon composition changes and load remains the same

  • often chronic tendinopathy

what happens when matrix metalloproteinases dont shut off during tendon healing

increase in capillaries, overproduction of collagen begins

what is the theory of “failed healing” in relation to chronic tendon injuries

tissue sampling show unequal and irregular crimping, a loosening of the waviness pattern and an increase in type III collagen

what are some risk factors for developing tendon injuries? differentiate between intrinsic and extrinsic

Extrinsic: excessive loading, training errors, improper equipment, environmental elements

Intrinsic: muscle imbalances, muscle/joint mobility restrictions, limb dominance, and leg-length discrepancy

what comorbidities and medicines can significantly impact tendon tolerance

diabetes mellitus

obesity

hypercholesterolemia

hypertension

what is the PEACE and LOVE principle, and how is it applied to treat tendon injuries during the inflammatory phase

PEACE: Protect, Elevate, Avoid Inflammatory, Compression, Educate

LOVE: Load, Optimistic, Vascularization, Exercise

Used to prevent prolonged inflammation (Chemical pain)

how should tendons be treated during the fibroblastic phase of healing

Gradual introduction of stress, increase collagen synthesis, improve collagen alignment, prevent excessive atrophy

how should we treat tendons in maturation

focus is on strengthening in order to increase cross-linking of collagen, increase fibril size in order to optimize tissue healing

what are the characteristics of chronic tendinopathy, and how does it differ from acute

inflammation is not present in the chronic phase, you may need to induce it in order to promote healing

what is paratendinopathy, what are its key characteristics

inflammation of paratenon , there is inflammation in the sheath plus degenerative changes in the tendon

what are some symptoms of achilles tendon injuries, and how does repeated strain lead to tendon degeneration

Sx: pain and popping

if done repeatedly, the patient does not have enough time to heal and angiofibrotic hyperplasia- degenerative process will precursor to failure

what factors contribute to adhesion formation during tendon healing

tendon suture, sheath injury, immobilization

how does tendon repair differ between long tendons and short tendons

Long tendon: immediate controlled passive mobilization

Short tendon: no real benefit for early mobilization, can lead to faster recovery of ROM but depends on the strength of the tissue (too much early motion can increase risk of failure)

what are the effects of early vs. delayed mobilization on tendon repair

Early led to better material properties, improved viscoelastic properties (better gliding function, less scarring)

how do medications like steroids affect tendon mechanical properties during healing

initially decreases inflammation but inhibits collagen synthesis

overuse leads to reduced tendon strength at the musculotendinous or ligament/bone interfaces

what are the potential benefits and limitations of platelet rich plasma in treating tendon injuries

Kick start the inflammatory phase, used in chronic inflammation to bring the environment back to inflammatory phase, not many side-effects, better exercise results

Not FDA approved so it is not covered by insurance

how do NSAIDs impact the healing process of collagen in tendons

reduce the healing process of collagen, can be effective for pain control

why must physical therapists consider medication effects when treating patients with tendon injuries

pain medications may skew the pain perception- may be increased risk for tissue damage

hormone therapy (birth control)- can increase laxity in tendon and ligaments and lead to hypermobility

what are the general treatment principles for tendinopathy, particularly in terms of load progression and specificity

identify and remove negative external forces/factors

establish stable baseline treatment

determine tensile load startin point

use symptoms to guide loading

control pain

address use of whole kinetic chain

employ specificity

use maximum

what are the main goals of treatment during the proliferative phase of tendon healing

lay down new collagen in functional pattern, increase motion, gentle tensioning of tissue which increases collagen production and decreases time needed for healing

what are the key objectives during the maturation phase of tendon healing, and how does loading rate affect tendon recovery

restore full pain-free function, increase strength, endurance, restore neuromuscular coordination

how does isometric and resistance training influence tendon stiffness

increase in stiffness after 4 days/week x 12 weeks

when strength training- increase reps before increasing intensity

what are the guidelines for cyclic stretching in tendon rehabilitation, and what risks are associated with long ter stretching

will produce the greatest long-term increases in tissue length

long-term stretching can cause a reduction of water content in tendon and lead to more brittle collagen fibers

what are some additional treatment strategies for tendinopathy

neuromuscular training, manual therapy, taping and bracing, dry needling, orthoses, shockwave therapy

how can shockwave therapy contribute to tendon healing, what is its effect on fibroblastic activity

increases production of cytokines, which increase fibroblastic activity

what role can dry needling and orthoses play in treating tendon injuries, and what are their current limitations based on evidence

dry needling- only case study evidence to support use in Achilles, subacromial pain syndrome

Orthoses- if foot posture is cause of stress on tendon, then likely will help, otherwise not useful