There are a range of tendinopathy presentations, from easily diagnosed with a local area of pain and clear pain response to tissue overload; through to patients with trickier presentations and multiple contributors to pain e.g. long term proximal hamstring or gluteal tendinopathy with a lumbar spine radiculopathy.
How can you diagnose and treat patients with complex tendinopathy presentations? How does the latest research around tendinopathy help us? I explore these issues and more with Dr Peter Malliaras in episode 68 of the Physio Edge podcast. We also explore:
- Do tendinopathy patients always present with a small area of pain, or can they have pain in larger, more diffuse areas?
- How will you identify tendinopathy or other structures that may be contributing to your patients symptoms?
- Clues in your patients' history to help you identify and differentiate tendinopathies, lumbar and SIJ referral
- Symptoms and how your treatment will differ in patients with paratenon and fat pad involvement
- How can you measure your patients load tolerance?
- What categories of tendinopathy patients can you use to help differentiate your treatment?
- How can you rehabilitate patients with tendinopathy?
- What role does biomechanics have?
- What advice can you provide to your patients about load management, symptoms and flareups?
- When is it ok for your patients to continue or return to running?
- What strength tests should your patients be able to complete before returning to running?
- If your patients are not tolerating running, which aspects should you modify first - frequency, intensity, type or duration?
- When are isometrics useful in your treatment?
- When can you start isotonic and plyometric exercises?
- How can you incorporate tendon neuroplastic training (TNT)?
Links associated with this episode
- Download your podcast handout
- Dr Peter Malliaras on Twitter
- Tendinopathy rehab blog with Dr Peter Malliaras
- Get your free trial Clinical Edge membership
- David Pope on Twitter
- Clinical Edge on Facebook
Other episodes of interest:
- PE 046 - Proximal hamstring tendinopathy with Tom Goom
- PE 042 – Treatment of plantaris and Achilles tendinopaty with Seth O’Neil
- PE 023 – Lower limb tendinopathies with Dr Pete Malliaras
Articles associated with this episode:
Coombes et at. 2016. Isometric exercise above but not below an individuals pain threshold influences pain perception in people with lateral epicondylalgia
Rio et al. 2015. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy
Silbernagel et al. 2007a. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled trial.
Silbernagel et al. 2007. Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy.