1.4 - Tendinitis and osis/opathy

tendinosis

what does PT usually see in the clinic, tendinitis or tendinosis

• rest

• NSAIDS

• maybe steroids

treatment for tendinitis (3)

total recovery

what does the recovery look like for tendinitis

paratendinitis

______________ is like tendinitis but it is inflammation of the external tendon

paratenon

___________ is loose connective tissue that is continuous with the tendon

T

T/F: there is NO inflammation with tendinosis

> couple days

what does the recovery look like for tendinosis

nonparallel

the collagen cells are (paraellel or nonparallel) in tendinopahty

neurovascularization

_________________ is when new blood vessels form which associated with pain in tendinopathy

• achilles

• posterior tibialis

• patellar

• rotator cuff (supra)

• biceps long head

• lateral humeral condyle (common extensor)

what are the 6 common places for tendinopathy

no (they look stiff due to bump but stiff tendons are good to dissipate force, tendinopathy tendons are less stiff and less able to handle force)

are tendons with tendinopathy stiff?

sure, there is no inflammation in the injury

should someone with tendinopathy/tendinosis take NSAIDS?

cross friction/transverse friction (perpendicular to disrupt the collagen in hopes of realignment/parallel and induced inflammation)

what type of massage should someone with tendinopathy receive?

eccentric

after unloading the tendon with tendinopathy, you want to reload the tendon through ___________ exercises, within pain tolerance

• tenocytes

• damaged

• increase

• tendon

reloading the tendon with tendinopathy leads to…

• activate __________ cells

• remove ___________ fibers

• (increase or decrease) synthesis

• remodel __________ fibers

• orthotics for arch support

• heel lift for achilles

• bracing (protection for tendon lengthening)

how can you unload the tendon with tendinopathy?

• complete eccentrics ex plan

• identify other impairments (LE, trunk)

• identify comorbidities

• integrate tendon loading program for long-term application

4 ways to prevent recurrence of tendinopathy

• alfredson (lots and lots of calf raises despite pain)

• silbernagel (we like this one, more effective phase program)

what are the 2 common eccentric ex program for the achilles

calf raise with ball squeeze, short foot

what is an exercise to target posterior tibialis

> 10 min (unrealistic)

the older information on tendinopathy suggested that one should stretch _______per day for tissue lengthening

• compressive; tensile

• isometric

• neutral

• high

• isotonic; eccentric

newer information on tendinopathy suggests:

• consider _________ load vs _________ load

• emphasis on ___________ ex in shortened range

• don’t go below __________

• (low or high) load

• progress to _________ ex and then to _________ ex

> 12 weeks

how long should the strength program/rehab process take for tendinopathy

• cortisone (anti-inflammatory, may impair healing, okay for short term)

• platelet rich plasma (mixed evidence, difficult to compare treatments)

• laser (mixed reviews, lack research)

• shockwave (effective for achilles, hamstring, lateral epicondyalgia)

• cellular therapy (promising, needs research)

what are the other 5 interventions for tendinopathy besides regular PT exercise and manual therapy?