TendinopathyDr. Richard Collins

Sport & Musculoskeletal PhysicianBedfordshire MSK

Talk overview

1. Tendinopathy cause2. Core principles of evidence based

treatment3. Place of adjunct treatment

1. Tendinopathy cause

Musculotendinous Overload

Main functions• Joint movement• Primary movers

• Joint stabilisation• Platform on which the primary movers can work

•Energy absorption, storage & release• Long, lower limb tendons• Part of propulsion mechanics

Achilles & Patellar Tendon

Functional Overload

Functional Overload

Structural degradation

Warning!

Structural changes are often a normal part of ageing

Not necessarily associated with symptoms

Interpret imaging carefully

Symptoms

•Pain (especially on activating normal function)•Swelling

Loss of function

2. Treatment Principles?

Restore Capacity!

What will do this?•Accupuncture?•Massage?•Supporting mechanics?•Muscle strengthening?

‘Physio’As insightful as the word ‘Drugs’

•Supporting mechanics

•Muscle strengthening

Physio ✅

How long does it take?•At least 12 weeks (c.f stress fracture)

•Are you doing them?! (taking their drugs)

•Are you doing them in a graded, increased way?

Approaches•Lower Limb Long Tendons?

•Rotator Cuff?

•Tennis Elbow?

3. Adjuncts

Only if struggling with rehab= Pain

Options?• Oral/Topical Analgesia?• Safe to tendons• Side-effects?

• Steroid Injections?• Analgesics• Weaken tendon collagen

• Autologous Blood/Platelet Rich Plasma?• Safe to tendons• What are they adding?

• Shockwave Therapy• Analgesic• Safe to tendons in skilled hands

Talk take home1. Tendinopathy cause

Functional Overload2. Core principles of evidence based treatment

Restore capacity through supporting function and strengthening muscle

3. Place of adjunct treatmentShockwave Therapy represents the best evidenced and safest approach – but only if appropriate rehab is failing

Questions?