Tendinopathy: Evidence-Informed Physical Therapy Clinical Reasoning

Abstract

Patients presenting with pain at the tendon, which is associated with physical tasks and activities that specifically load that tendon, are at the center of this special issue. The current terminology for a symptomatic tendon presentation is tendinopathy, as this does not denote an underlying pathology, but rather signals that all is not well in the tendon. Tendinopathy is a prevalent and substantial problem, as it interferes with a person's capacity to lead a physically active and healthy life, which has a considerable flow-on effect on society in general. This issue deals with the contemporary physical therapy management of tendinopathy by providing a mix of evidence review and clinical expert opinion on commonly presenting tendinopathies of the lower and upper limbs. J Orthop Sports Phys Ther 2015;45(11):816-818. doi:10.2519/jospt.2015.0110.

Interventions used for Rehabilitation and Prevention of Patellar Tendinopathy in athletes: a survey of Brazilian Sports Physical Therapists

“…The answer options regarding the questions about interventions most frequently used were: eccentric protocol, 17---19 eccentric/isometric/concentric strengthening, 20---23 stretching, 10,20,24 joint mobilization, 20,25 foot orthotics, 20,26 electrotherapy, 27---30 lumbo-pelvic stabilization, 1,3,9 miofascial release, 31 functional training, 1,7,13 lower limb stabilization, 1,7,13,32 taping, 33,34 transverse friction, 3,9,35 plyometric, 1,3,9 load control, 1,3,8,9 education, 1,3,9 cryotherapy 1,3,9,36 and others. The physical therapist could select multiple interventions.…”

“…8 In addition to local interventions, physical therapists should also identify and treat possible non-local causes of PT based on clinical reasoning and on scientific evidence, such as hip muscles weakness and ankle dorsiflexion ROM. 1,7,9,10 Finally, proper criteria to return to sport should be considered at the end of rehabilitation to promote a safe sport practice. 1,7,11,12 Most of the clinical trials regarding the effects of different interventions on athletes with PT lack proper follow-up data.…”

Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues and Inadequate Outcomes

“…However in a study in an active population, more than a quarter of patients reported performing the exercises at an intensity reduced to less than half of what was prescribed [64]. Regardless of the intervention population, individualized exercise programs should be adequately supervised, reviewed, and progressed to ensure adherence and resolution of the tendinopathy [123]. The effectiveness of resistance training alone may increase with intensive care taking, such as having patients perform exercises with supervision four times per week for eight weeks as opposed to at home and unsupervised [124].…”

Advances in the development of gene therapy, noncoding RNA, and exosome‐based treatments for tendinopathy

“…18 While these conservative treatments may reduce tendinopathy symptoms substantially, there is a lack of diseasemodifying therapeutics to address the underlying pathology in tendinopathy. 19 A significant challenge in the development of an effective treatment is the complexity of the altered healing of tendons once pathological changes set in. 4 Therefore, there is an urgent need to develop new strategies to enhance tendon healing.…”

“…The first line of treatment for tendinopathy includes rest, nonsteroidal anti‐inflammatory medication, and physical therapy 18 . While these conservative treatments may reduce tendinopathy symptoms substantially, there is a lack of disease‐modifying therapeutics to address the underlying pathology in tendinopathy 19 . A significant challenge in the development of an effective treatment is the complexity of the altered healing of tendons once pathological changes set in 4 .…”