Tendinopathy. 5 Minute Assessment

Transcription

1 Tendinopathy 5 Minute Assessment

2 Diagnoses Observe and palpate tendon and surrounding tissues Assessment Foot/Ankle mobility - WBDF - Hypomobility - Hypermobility - 1st MTPJ extension - Distal TFJ Knee mobility - Flexion - Extension - Hyper-Extension - PFJ Hypomobility/ Hypermobility Hip mobility - Flexion - Extension (Thomas Test) - IR - ER - Abduction, Lx lateral collapse Flexibility - Knee to wall - Toe touch - Prone heel to bum

3 Achilles Tendinopathy Inflammatory Insertional Midportion - AS,RA,PA, Gout - Severs Disease (Mainly adolescent population) - Fat Pad - Retrocalcaneal bursa - Paratendon - Tear/ partial tear - Accessory Soleus - Plantaris Patella Tendinopathy Tibial Tuberosity Inferior Pole - Osgood Schallatters - Infrapatella bursitis - Pes Ans - PFJ - Fat pad - Singding larsson johansson Functional Assessment Squat Stairs Gait cycle Hop/Jump

4 Treatment Strategy Address Extrinsic factors with patient Isometric loading protocol Achilles Mid-range (ROM) BW heel raise seconds 3-5 reps x2 Daily Isometric loading protocol Patella Mid-range (ROM) 40-50% MVC (leg Ext) DL Squat mid range hold sec 3-5 reps x2 daily (see table overleaf for irritation, If pain persists for >3 days a period of rest should be advised) Pain Pathology Irritable Pain >3 days of irritation Reactive, Dis-repair Stable Pain <24 hours of irritation Degenerative, Tear A polypill for acute tendon pain in athletes with tendinopathy? Treatment of tendon pain Selective NSAID prescription Recent research and clinical experience suggests that NSAIDs may act via mechanisms other than those which alter the standard inflammatory cascade. Ibuprofen, indomethacin and naproxen have been demonstrated to inhibit aggrecan expression in in-vitro tendon preparations (Ferry et al. 2007)

5 The use of ibuprofen in tendinopathy is supported by studies of tendon repair after transection, where ibuprofen was the only NSAID of six NSAIDs not to have a detrimental effect. TNF inhibitors Some evidence exists that TNF may affect both structural change and pain in activity-induced tendinopathy. Up-regulation of TNF is also associated with apoptosis. Apoptosis may be a key process in tendinopathy in humans as apoptotic cell death was recently shown to be a feature of patellar tendinopathy in humans. Doxycycline, commonly used in acne for both antibacterial and antiinflammatory effects, has been shown to block the action of TNF. Doxycycline also inhibits connective tissue breakdown. Paradoxically,most anti-inflammatory agents (naproxen celecoxib,diclofenac) increase TNF levels (Rubin, 2004) Dosage Standard anti-inflammatory (Ibuprofen 400 mg tds) and anti-microbial doses (Doxycycline 100 mg daily) are given to athletes with acutely painful tendinopathy. The medication is continued for days with an impression of optimal effect by the third week. The addition of non-pharmaceutical medications such as green tea or omega 3 fatty acids can be without restriction

6 References Jill Cook. (2008). A polypill for acute tendon pain in athletes with tendinopathy. Journal of science and medicine in sport. 11 (11), Khan KM, Bonar SF, Cook JL, et al (1999) Almekinders L, Temple J. (1998) Riley GP, Cox M, Harrall RL, et al (2001) Ferry ST, Dahners LE, Afshari HM, et al (2007) Riley GP, Cox M, Harrall RL, et al (2001) Ferry ST, Dahners LE, Afshari HM, et al (2007) Rubin BK (2004)

7 Notes

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