Tendinopathy Rehabilitation: Difference between revisions
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== Introduction == | == Introduction == | ||
The development of a rehabilitation plan for an individual presenting with confirmed symptomatic tendinopathy requires complex clinical reasoning, with reference to the pathoanatomical diagnosis. Tendon pathology and subsequent rehabilitation will vary considerably depending on the site of pathology; stage of the tendinopathy; functional assessment; activity status of the person; contributing issues throughout the kinetic chain; comorbidities; and concurrent presentations<ref name="Scott et al" />. | The development of a rehabilitation plan for an individual presenting with confirmed symptomatic tendinopathy requires complex clinical reasoning, with reference to the pathoanatomical diagnosis. Tendon pathology and subsequent rehabilitation will vary considerably depending on the site of pathology; stage of the tendinopathy; functional assessment; activity status of the person; contributing issues throughout the kinetic chain; comorbidities; and concurrent presentations<ref name="Scott et al" />. | ||
Our key goal in tendinopathy rehabilitation is improving the capacity of the tendon and muscle to manage load<ref name="Goon1">Goon T. Tendinopathy – rehab progression – part 1. Accessed online at [http://www.running-physio.com/tendinopathy1/ Tendinopathy – rehab progression – part 1] 30 Jan 2016</ref>. Each component of the rehabilitation programme, in particular loading, must be manipulated in relation to the nature, speed and magnitude of the forces applied to the muscle/tendon/bone unit in order to achieve the goals of the particular management phase without causing an exacerbation of the pathological state or pain<ref name="Scott et al">Alex Scott, Sean Docking, Bill Vicenzino, Håkan Alfredson, Johannes Zwerver, Kirsten Lundgreen, Oliver Finlay, Noel Pollock, Jill L Cook, Angela Fearon, Craig R Purdam, Alison Hoens, Jonathan D Rees, Thomas J Goetz, Patrik Danielson. [http://bjsm.bmj.com/content/early/2013/04/11/bjsports-2013-092329.full.html Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012]. Br J Sports Med doi:10.1136/bjsports-2013-092329</ref>. | Our key goal in tendinopathy rehabilitation is improving the capacity of the tendon and muscle to manage load<ref name="Goon1">Goon T. Tendinopathy – rehab progression – part 1. Accessed online at [http://www.running-physio.com/tendinopathy1/ Tendinopathy – rehab progression – part 1] 30 Jan 2016</ref>. Each component of the rehabilitation programme, in particular loading, must be manipulated in relation to the nature, speed and magnitude of the forces applied to the muscle/tendon/bone unit in order to achieve the goals of the particular management phase without causing an exacerbation of the pathological state or pain<ref name="Scott et al">Alex Scott, Sean Docking, Bill Vicenzino, Håkan Alfredson, Johannes Zwerver, Kirsten Lundgreen, Oliver Finlay, Noel Pollock, Jill L Cook, Angela Fearon, Craig R Purdam, Alison Hoens, Jonathan D Rees, Thomas J Goetz, Patrik Danielson. [http://bjsm.bmj.com/content/early/2013/04/11/bjsports-2013-092329.full.html Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012]. Br J Sports Med doi:10.1136/bjsports-2013-092329</ref>. | ||
== Rehabilitation Progression == | == Rehabilitation Progression == | ||
Goon<ref name="Goon1" /> suggests considering tendinopathy rehabilitation in phases: | Goon<ref name="Goon1" /><ref name="Goon2">Goon T. Tendinopathy – functional rehab. Accessed online at [http://www.running-physio.com/tendinopathy2/ Tendinopathy – rehab progression – part 1] 30 Jan 2016</ref> suggests considering tendinopathy rehabilitation in phases: | ||
[[Image:Tendinopathy rehab progression.png|center]] | |||
=== Phase 1 - reduce pain<br> === | |||
Key to reducing pain is managing the load on the tendon: | |||
#Avoid activities that place a compressive load on the tendon, usually this is any activity that would involve stretching the effected muscle or direct tendon compression. | |||
#Cut out activities that involve the Stretch-Shortening-Cycle (SSC). The SSC occurs when the tendon has to behave a like a spring, stretching then shortening to store and then release energy. | |||
#Anti-inflammatory medications, such as ibuprofen can be used to help to reduce the reactive response. | |||
#sometric exercises can help to reduce pain<ref name="Rio1">Ebonie Rio, Dawson Kidgell, Craig Purdam, Jamie Gaida, G Lorimer Moseley, Alan J Pearce, Jill Cook. [http://bjsm.bmj.com/content/49/19/1277.abstract?cited-by=yes&legid=bjsports;49/19/1277 Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy]. Br J Sports Med 2015;49:1277–1283.</ref><ref name="Rio2">Mathijs van Arka, Jill L. Cookb, Sean I. Dockingb, Johannes Zwervera, James E. Gaidab, Inge van den Akker-Scheeka, Ebonie Riob. [http://www.sciencedirect.com/science/article/pii/S1440244015002315 Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial]. Journal of Science and Medicine in Sport, available online 7 December 2015</ref>. | |||
=== Phase 2 - improve stength === | |||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
Revision as of 19:08, 30 January 2016
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Introduction[edit | edit source]
The development of a rehabilitation plan for an individual presenting with confirmed symptomatic tendinopathy requires complex clinical reasoning, with reference to the pathoanatomical diagnosis. Tendon pathology and subsequent rehabilitation will vary considerably depending on the site of pathology; stage of the tendinopathy; functional assessment; activity status of the person; contributing issues throughout the kinetic chain; comorbidities; and concurrent presentations[1].
Our key goal in tendinopathy rehabilitation is improving the capacity of the tendon and muscle to manage load[2]. Each component of the rehabilitation programme, in particular loading, must be manipulated in relation to the nature, speed and magnitude of the forces applied to the muscle/tendon/bone unit in order to achieve the goals of the particular management phase without causing an exacerbation of the pathological state or pain[1].
Rehabilitation Progression[edit | edit source]
Goon[2][3] suggests considering tendinopathy rehabilitation in phases:
Phase 1 - reduce pain
[edit | edit source]
Key to reducing pain is managing the load on the tendon:
- Avoid activities that place a compressive load on the tendon, usually this is any activity that would involve stretching the effected muscle or direct tendon compression.
- Cut out activities that involve the Stretch-Shortening-Cycle (SSC). The SSC occurs when the tendon has to behave a like a spring, stretching then shortening to store and then release energy.
- Anti-inflammatory medications, such as ibuprofen can be used to help to reduce the reactive response.
- sometric exercises can help to reduce pain[4][5].
Phase 2 - improve stength[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 Alex Scott, Sean Docking, Bill Vicenzino, Håkan Alfredson, Johannes Zwerver, Kirsten Lundgreen, Oliver Finlay, Noel Pollock, Jill L Cook, Angela Fearon, Craig R Purdam, Alison Hoens, Jonathan D Rees, Thomas J Goetz, Patrik Danielson. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012. Br J Sports Med doi:10.1136/bjsports-2013-092329
- ↑ 2.0 2.1 Goon T. Tendinopathy – rehab progression – part 1. Accessed online at Tendinopathy – rehab progression – part 1 30 Jan 2016
- ↑ Goon T. Tendinopathy – functional rehab. Accessed online at Tendinopathy – rehab progression – part 1 30 Jan 2016
- ↑ Ebonie Rio, Dawson Kidgell, Craig Purdam, Jamie Gaida, G Lorimer Moseley, Alan J Pearce, Jill Cook. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med 2015;49:1277–1283.
- ↑ Mathijs van Arka, Jill L. Cookb, Sean I. Dockingb, Johannes Zwervera, James E. Gaidab, Inge van den Akker-Scheeka, Ebonie Riob. Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. Journal of Science and Medicine in Sport, available online 7 December 2015
