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Tendinopathy
Management & Treatment
Rehab progression
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Year 1 Physio > MSK lower quadrant > Tendinopathy > Management & Treatment > Rehab progression
15 cards
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Rehab progression – Phase I -
pain
relief:
Isometric
work, up to
70
% MVC (Rio et al 2015, [patellar])
Not effective in all (O’Neill et al 2018, [Achilles], Holden et al 2019 [patellar])
Rehab progression - Phase 2 - build
strength
:
isotonic
progression through range
Rehab progression - Phase 3 -
power
development:
Incorporation of
speed
and
elastic
recoil
Rehab progression - Phase 4 - return to
sport
Maintenance
management of
load
Rehab progression summary
A)
unload
B)
isometric
C)
capacity
D)
pain
E)
isotonic
F)
explosive
G)
strength
H)
endurance
I)
power
J)
functional
10
Phase 1:
Isometric
holds 45 -
60
secs x
4
,
4
days a week
Use
70
% MVC, good to load
Pain
free positions initially
Avoid
compression
positions
Use if isotonic >
3
/10 pain
Phase 2 - Limited range:
Aim to develop
strength
Isotonic
exercise –
slow
(6 secs) and
heavy
Minimal
pain
6
-
10
x
4
for
3
days a week (
high
load)
Or,
15
x
4
done
daily
(
Low
load)
Phase 2 - Progressive range:
Improve load
tolerance
Moving towards
function
More
provocative
Phase 3:
Energy
storage and
power
loading
Mostly for
athletic
populations
Minimal
pain
Speed
work into range
Development of kinetic chain motor control
Volume
before
intensity
6
-
8
weeks (??concurrent with activity)
Phase 4:
Sports
specific activity
Gradual
increase
Overlaps with elements of phase
3
Long
term
maintenance
programme advisable/essential beyond
resolution
of symptoms
sample rehab protocol
Consider dosage =
frequency
x
volume
(days per week x sets/reps)
Allow time for
recovery
Repetitive hard days is too much
Monitor by 24h response (VAS 0-3 ok, 3-5 caution, 6-10 avoid)
Avoid
spikes
in activity –
slow
progression, use % of
previous
load
High
load
for
tendons
involve SSC components eg
jump
, hop
What to expect during rehab:
Pain
- during rehab not as important as reactivity next day
Education
& expectations -
Slow
recovery, ensure buy-in and compliance
Consider
biopsychosocial
contribution (fear, threat, etc) in acute/chronic presentation
Investigations - Structural change poorly correlated with symptoms, but structure changes – UTC studies
Exercise is for
muscle
as well as
tendon
(M-T unit)
Benefits
of exercise go beyond physiological changes locally -
strength
,
sensitivity
,
confidence
, tissue
capacity
Less common adjuncts and alternatives to exercises:
Surgery
– minimal invasive, outside tendon
High Volume
Injections
Excision
Scrapping
Plantaris
Shock Wave
Therapy
More common adjuncts and alternatives to exercises:
Corticosteroids
GTN
Ice
Taping
Sclerosing
agents
Alternative
medicine
Platelet
Rich
Plasma
PRP
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