Tendons are very complex when it comes to rehabilitation and management. I wrote my masters dissertation on the subject and the amount of conflicting thoughts and opinions was obvious. One common theme though was the need to load the tendon. I found these key points while reading an extract from ‘Tendinopathy: physiotherapy and rehabilitation – Dr Bruce Paton, Clinical Specialist Physiotherapist, Lower Limb Extended Scope Practitioner, University College Hospital’.
These are a great summary of what the aims of the various stages of rehabilitation are. Your goals should be discussed with the therapist so they are achievable and specific to your lifestyle or sport. You’ll most likely be addressing range of movement at the joints, strength or weakness of associated muscles and loading though the joints, for example flat feet with Achilles tendinopathy.
Optimum rehabilitation goals are to restore:
- the load function of the tendon
- adequate tendon stiffness
- adequate stretch-shortening behaviour
- load dissipation
- an effective kinetic chain
- a pain-free state.
Loading is one of the most commonly researched areas of tendon rehabilitation. As a result there’s a wide range of data to support various types of loading. Loading has been shown to stimulate insulin like growth factor, an essential element for the growth and remodeling of the tendon.
- Concentric – some evidence that this may be effective
- Eccentric – best treatment available. Clears majority of midsubstance but not all
- Isometrics – give some short-term pain relief and cortical inhibition, and may be good for reactive/compressive tendinopathy
- Heavy slow resistance – seems to be effective in patellar tendinopathy, now also evidence in Achilles tendinopathy.
Other rehabilitation considerations:
This is where we look to address other factors that can influence the patients reason for developing the injury, their perception of the injury as well as some consequences that either contributed or developed as a result of the injury.
- Possibly the kinetic chain
- Neurodynamics have a role
- Address psychosocial factors such as fear avoidance
- Mixed evidence for pushing through pain
- Address metabolic factors such as obesity.
About the author
Michael is an osteopath, trainee strength coach and aspiring powerlifter