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Various physical therapies in TENDINOPATHY

Various physical therapies in TENDINOPATHY. Jakub Jeníček. Objectives. Definition of the clinical condition and diagnostics Basics of patophysiology Most common types of tendinopathy Goals of treatment

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Various physical therapies in TENDINOPATHY

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  1. Various physical therapies inTENDINOPATHY Jakub Jeníček

  2. Objectives • Definition of the clinical condition and diagnostics • Basics of patophysiology • Most common types of tendinopathy • Goals of treatment • Various treatment approaches – from conventional up to advanced ones

  3. Tendinopathy – definition and diagnostics • primary disorder of the tendons – common, often chronic, difficult treatment • diagnosis is in most clinical • activity-related pain, pain at rest • decreased function, ADL • stiffness of the tendon • localized swelling • palpable crepitations • muscle tone imbalances

  4. Tendinopathy – pathogenesis • repetitive or excessive mechanical overloading and subsequent activation of noxious mechanisms • tendon loses its reparative capacity • inflammation and degeneration work together in the pathogenic cascade • confusion in terminology – tendinitis / tendinosis / tendinopathy

  5. Tendinopathy – most common types • certain tendons are especially susceptible to degenerative pathology: • rotator cuff in the shoulder • forearm extensor tendons (tennis elbow) • forearm flexor tendons (golfer´s elbow) • patella tendon (jumper´s knee) • Achilles tendon • small feet muscles tendon

  6. Tendinopathy – epidemiology • most commonly diagnosed musculoskeletal disorders (Forde et al., 2005): • tendinopathies (19%) • discopathies (18%) • shoulder bursopathies (15%) • carpal tunnel syndrome (12%) • sum of all other disorders (36%) • high lifetime prevalence in sportsmen • tennis (40%!), volleyball (20%) • squash, basketball, soccer, running, jumping, cycling

  7. Tendinopathy – therapeutic intervention • in many cases remains uneffective – especially when treatment is only analgesic or anti-inflammatory monotherapy! • choice of adequate therapy: • phase of disorder • - acute / chronic • - more inflammatory / degenerative nature • goals of treatment...

  8. Tendinopathy – Goals of treatment • analgesia • reducing inflammation • elimination of the swelling • tendon structure recovery (elasticity) • muscle normotonia, trigger points elimination • detection of primary causes of the disorder: • muscle imbalance in segment, hypertonia • incorrect movement stereotypes • overloading activities, ergonomics • other individual factors

  9. Tendinopathy – range oftreatments • Conventional treatment • Non-steroidal anti-inflammatory drugs, corticosteroids • Biomechanical alterations – braces, taping, Kinesio-taping • Cryotherapy, Rest • Manual therapy techniques • Therapeutic ultrasound • Electrotherapy, Iontophoresis • Advanced treatment • Low-intensity laser therapy • Shockwave therapy • Stem-cell or gene therapy • Platelet-rich plasma • Sclerosant injections • numerous different types of treatment in literature • poor evidence base – mostly empirical findings from clinicians

  10. Tendinopathy – treatment in acute stage • predominance of inflammation • pain, swelling, redness, crepitations • typically occurs after prolonged stereotypical work (e.g. screwing) • treatment • rest, cryotherapy • orthotics – supportive braces, Kinesio-taping • drugs – NSAId, antiphlogistics, corticosteroids injections • manual therapy techniques • analgesic physical modalities – electrotherapy – TENS, DD, interferential currents • myorelaxant physical modalities – ultrasound or combined therapy ultrasound + electro • distinguish acute x chronic tendinopathy!

  11. Tendinopathy – clinical suggestions • most effective combination of physical modalities for patient with acute tendinopathy: • analgesia • electrotherapy – DD currents – sequence of DF (1 min.) + CP (5 min.) x LP (6 min.), polarity reverse in the middle • myorelaxation • ultrasound – subaqual application from the distance of 10 cm (1 MHz, 1 W/cm2, 20% duty factor) • combined therapy (electro + ultrasound) for trigger points – 1 cm2 ultrasound head (3MHz, 0,5 W/cm2, 50% duty factor)+ large electrode (TENS, f 100 Hz, motor treshold intensity)

  12. Tendinopathy – treatment in chronic stage • predominance of degeneration • pain, structural changes in tendon, stiffness, dysfunction • typically occurs after long-term overloading and microtraumatization (incorrect sport load, work position) • treatment • manual therapy techniques • physical modalities to modify the structure and promote healing of affected tendon: • laser therapy (anti-inflammatory, analgesic, biostimulation) • shockwave therapy (analgesic, reparative)

  13. Tendinopathy – clinical suggestions • most effective combination of physical modalities for patient with chronic (degenerative) tendinopathy: • analgesia and biostimulation, reparation • laser therapy – focused with laser probe • dose 20 J/cm2, continuous frequency do deliver energy to the tissue • dose 10 J/cm2, pulsed frequency to modulate desired effect • structure modification and healing • shockwavetherapy– optimum 2 bar in pathologic spot, 2000 pulses with frequency 10 - 15 Hz

  14. Thank you for your attention!

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