Tendinopathy can result from overuse and is experienced in the affected tendon as pain with activity, focal tenderness to palpation, and decreased ability to tolerate tension, which results in decreased functional strength. While tendinopathy often occurs in those who are active, it can occur in those who are inactive. Research has shown that an eccentric exercise program can be effective in the treatment of tendinopathies. The earliest studied was the Achilles tendon, and subsequent studies have shown benefits using eccentric exercises on other body regions including the patellar tendon, proximal lateral elbow, and rotator cuff. In this article, we review the research on using an eccentric exercise program in the treatment of painful tendinopathy and proposed mechanisms for why eccentric exercises are effective in treating this and then finish by providing a general framework for prescribing an eccentric exercise program to those with a symptomatic tendinopathy.
Osteoarthritis is one of the most frequent and chronic conditions that affect the U.S. population. Use of intra-articular injections is one of the established treatment options available in the nonoperative care for the management of symptomatic osteoarthritis. Common injectable medications include corticosteroids, hyaluronic acid, and other less traditional compounds (for example, botulinum toxin). Corticosteroids work by anti-inflammatory and antinociceptive actions. Corticosteroids have been shown to decrease pain and symptoms associated with osteoarthritis for up to 3 weeks. Hyaluronic acid has an unclear mechanism of action, but it is thought to promote the restoration of hyaluronic acid within an osteoarthritic joint. The efficacy of hyaluronic acid is modest and is most beneficial between 5 and 13 weeks after treatment. Other injectable compounds have been studied and include botulinum toxin type A, which has been theorized to work as an antinociceptive agent. One must be aware of the potential adverse effects associated with these medications. For all of these injectable treatments, the placebo effect must not be overlooked, because it has be demonstrated in multiple studies that these medications provide similar relief of pain when compared with placebo. Image guidance with ultrasound or fluoroscopy may be considered when performing intra-articular injections to improve accurate placement of medication.
Symptomatic tendinopathy can be a disabling condition for athletes. Common sites of tendinopathy in athletes include the rotator cuff (RTC), Achilles, and patellar tendons. Advanced imaging modalities, such as magnetic resonance imaging and ultrasound occasionally identify tendinopathic changes in asymptomatic individuals. Such asymptomatic changes have been documented in the RTC, Achilles, and patellar tendons of athletes. In the RTC, tendinopathy, partial-, and full-thickness tears have been demonstrated in asymptomatic athletes, though only small numbers of these athletes may develop symptoms despite prolonged periods of ongoing, competitive play. In the Achilles and patellar tendons, neovascularization, hypoechogenicity, and tendon thickening are commonly noted findings in asymptomatic athletes, and though all have been associated with tendon pain in the literature, there is some inconsistency as to which are the strongest predictors of future tendon pain. Evidence on how best to address or intervene upon such asymptomatic changes is limited.
Purpose The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits. Methods The founders of SPINE20 advocacy group coordinated with G20 Saudi Arabia to conduct the SPINE20 summit in 2020. The summit was intended to promote evidence-based recommendations to use the most reliable information from high-level research. Eight areas of importance to mitigate spine disorders were identified through a voting process of the participating societies. Twelve recommendations were discussed and vetted. Results The areas of immediate concern were “Aging spine,” “Future of spine care,” “Spinal cord injuries,” “Children and adolescent spine,” “Spine-related disability,” “Spine Educational Standards,” “Patient safety,” and “Burden on economy.” Twelve recommendations were created and endorsed by 31/33 spine societies and 2 journals globally during a vetted process through the SPINE20.org website and during the virtual inaugural meeting November 10–11, 2020 held from the G20 platform. Conclusions This is the first time that international spine societies have joined to support actions to mitigate the burden of spine disorders across the globe. SPINE20 seeks to change awareness and treatment of spine pain by supporting local projects that implement value-based practices with healthcare policies that are culturally sensitive based on scientific evidence.
Sleep has been found to have wide-ranging effects on sports performance and overall well-being. Recent research has found evidence relating chronic suboptimal sleep with the risk of musculoskeletal pain and sports injury. The amount of sleep that consistently has been found to be associated with increased risk of injury is ≤7 h of sleep, which when sustained for periods of at least 14 d has been associated with 1.7 times greater risk of musculoskeletal injury. However, it is unknown if sleep loss predisposes the athlete to specific types of musculoskeletal injuries. The role of sleep on musculoskeletal pain is important to understand as studies in both children and adults have found that suboptimal sleep more consistently predicts next-day pain as compared with pain predicting subsequent sleep loss. Despite the evidence that certain aspects of sleep behavior seem to increase the risk of musculoskeletal injury and pain, sleep should be considered as only a part of the athlete's overall health and well-being when assessing the athlete for risk of injury.
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