Tendinitis effective treatment of an overuse injury


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By: RehabWorks Intern
Jessica Dowdy - UCF Senior - Athletic Training

Published in: Health & Medicine, Sports
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  • Examples of how tendinitis can occur with each tendon…..
  • Explain how tendinitis can occur with each tendon
  • Explain how there is poor blood supply to certain portions of the tendon (usually the middle) making it more difficult for the tendon to rejuvenate Discuss how some tendon are susceptible to inflammation in anatomy slides
  • Explain how the lever arm works with braces
  • Quads, calves, biceps, rotator cuff examples of eccentric exercisesExplain concentric against the resistance, eccentric with resistance
  • Standing on both legs, raise up on your toes. When you have reached the end of your available range shift weight onto one leg and SLOWLY lower back down on single leg.
  • Loss of flexibility can be a contributing factor to tendinopathy, so emphasize flexibility exercisesStart eccentric, go to concentric, make exercises low-impact and increase as tolerated.m
  • Platelets- bodies in blood that stick to a wound and form clots to promote healing. High in growth factors: fibroblast, vascular, connective tissue,etc. Vital in cell proliferation, collagen synthesis, and angiogenesis (important process in maintenance, and repair of tendontissue
  • Corticosteroids- can worsen an injury due to athlete or individual feeling better so they think they can do more and cause further injury. Great short term little affect long term- can be safety issue. Several cases of Achilles tendon ruptures after injection. PRP- 73% success rate to the 49% steroid at 12-month follow upAWB- still new information, in study conducted 60 candidates were involved half given steroid other half given AWP, AWB all findings were positive for strength improvement and elimination of pain, unlike steroid which just eliminated pain- regenerates collagen and angiogenic response*
  • Wait for more info for AWB
  • Tendinitis effective treatment of an overuse injury

    1. 1. Tendinitis: effective treatment of an overuse injury Jessica Dowdy Athletic Training Student University of Central Florida
    2. 2. o What is a tendon? • A band of connective fibrous tissue that connects muscle to bone • Ex: patellar tendon, biceps tendon, achilles tendon, etc. o What is inflammation? • Reaction of a tendon from irritation, injury, or infection • Characterized by pain, swelling, loss of function, and warmth • Redness also occurs but is unseen on the surface
    3. 3. o Tendinopathy: a painful condition of an overuse injury in and/or around a tendon • Tendinitis: inflammation of a tendon • Tenosynovitis: inflammation of the sheath surrounding a tendon • Tendinosis: a chronic degeneration of a tendon without the presence of inflammation, resulting in multiple tears in the tendon
    4. 4. All tendons can be susceptible to tendinitis o Commonly injured tendons: o • Patellar tendon • Achilles tendon • Biceps tendon (proximal) • Rotator cuff tendons (supraspinatus, infraspinatus, subscapularis, teres minor)
    5. 5. Biceps tendon Achilles tendon Patellar tendon
    6. 6. Subscapularis and Supraspinatus Teres Minor and Infraspinatus
    7. 7. o One of two causes 1. Acute overuse- a tendon is under excessive, prolonged stress not allowing the tendon to heal. • Ex: repetitive use 2. Chronic- when acute tendinitis is not treated properly • • Ex: tendinosis Tears/Ruptures
    8. 8. o Cardinal signs of inflammation • Redness/discoloration • Pain or tenderness • Swelling • Warmth • Loss of function o Pain or tenderness• Along tendon, commonly at joint • That worsens with activity
    9. 9. o RICE • Rest • Ice • Compression • Elevation o Brace • Used to shorten lever arm of the tendon • Typically used at knee and elbow
    10. 10. o NSAIDs • Non-steroidal anti-inflammatory drugs • Aspirin • Ibuprofen (Advil, Motrin) • Naproxen (Aleve)
    11. 11. o Acute rehabilitation focuses mostly on RICE • You want to decrease inflammation as soon as possible and try to rest the tendon so that it has time to heal instead of exacerbating the injury o Chronic rehabilitation focuses on pain management, strengthening, and stretching. • Goal is to reverse the damage of being a chronic injury
    12. 12. o Eccentric exercises are heavily used in the rehabilitation of tendinopathies • Eccentric contraction- muscle fibers elongate under tension • Concentric contraction- muscle fibers shorten under tension
    13. 13. o Stretching o Strengthening surrounding musculature o Cross friction massage o 80% of patients that were treated solely with rehabilitation incorporating eccentric exercises reported complete pain relief
    14. 14. o Injections• Corticosteroids- is a steroid hormone used to decrease inflammation • Autologous Whole Blood- uses a patient’s blood and injects it into the injury site to provide blood and platelets, since tendons tend to lack strong blood flow, this helps promote healing • Platelet-Rich Plasma (PRP)- taking the person’s blood that has an above baseline of platelets and injecting into the tendon
    15. 15. Corticosteroids- good for temporary relief, has no long term affects o PRP- great success rate if followed with eccentric exercises o o PRP- 73% success rate to the 49% steroid at 12-month follow up o Autologous Whole Blood- good results in studies conducted however still not enough information
    16. 16. o Surgery • Tenotomies- cutting the tendon to help the tendon • • • • lengthen so there’s not as much tension Athroscopic clean up Surgery- effective, try to avoid if possible due to longer healing process from just having a surgery and then needing rehabilitation to strengthen Surgery should be LAST resort due to longer treatment time 67% of patients who had open debridement reported decrease in pain and increase of function.
    17. 17. Start Conservatively! o Try NSAIDs, RICE, and rehabilitation since other treatments will require this as well o All individuals are different choose treatment accordingly o Corticosteroids are only effective in short term pain reduction, try PRP instead since there are better results. o
    18. 18. o o o Skjong CC, Meininger AK, Ho S. Tendinopathy treament: where is the evidence?. Clinic in Sports Medicine. 2012; 31.2: 329-350. Houglum PA. Therapeutic exercise for musculoskeletal injuries. Human Kinetics. 3rd ed. Champaign, IL: Perrin DH; 2010: 445-457. Hak DJ, Sanchez A, Trobisch P. Quadriceps tendon injuries. Orthopaedics. 2010; 33.1.