The continuum of tendon pathology : Current view and clinical implications
- Authors: Cook, Jill , Rio, Ebonie , Purdam, Craig , Girdwood, Michael , Ortega-Cebrian, Silvia , Docking, Sean
- Date: 2017
- Type: Text , Journal article
- Relation: Apunts Medicina de l'Esport Vol. 52, no. 194 (2017), p. 61-69
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- Description: Cook and Purdam first proposed the Continuum model in 2009, with the aim of improving the understanding of the complexity of tendon pathologies. The Continuum is based on three states of tendon structure: reactive tendon, tendon disrepair and degenerative tendon. In contrast to other proposals, the Continuum model describes continuous changes in tendon structure. Each state of tendon structure represents a particular clinical presentation and requires a particular type of management. Evidence seen in histopathological studies, imaging and clinical studies all support the Continuum model for the analysis of tendon pathologies. © 2017 Consell Català de l'Esport. Generalitat de Catalunya
Tendon neuroplastic training : Changing the way we think about tendon rehabilitation : A narrative review
- Authors: Rio, Ebonie , Kidgell, Dawson , Lorimer Moseley, Graham , Gaida, Jamie , Docking, Sean , Purdam, Craig , Cook, Jill
- Date: 2016
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 50, no. 4 (2016), p. 209-215
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- Description: Tendinopathy can be resistant to treatment and often recurs, implying that current treatment approaches are suboptimal. Rehabilitation programmes that have been successful in terms of pain reduction and return to sport outcomes usually include strength training. Muscle activation can induce analgesia, improving self-efficacy associated with reducing one's own pain. Furthermore, strength training is beneficial for tendon matrix structure, muscle properties and limb biomechanics. However, current tendon rehabilitation may not adequately address the corticospinal control of the muscle, which may result in altered control of muscle recruitment and the consequent tendon load, and this may contribute to recalcitrance or symptom recurrence. Outcomes of interest include the effect of strength training on tendon pain, corticospinal excitability and short interval cortical inhibition. The aims of this concept paper are to: (1) review what is known about changes to the primary motor cortex and motor control in tendinopathy, (2) identify the parameters shown to induce neuroplasticity in strength training and (3) align these principles with tendon rehabilitation loading protocols to introduce a combination approach termed as tendon neuroplastic training. Strength training is a powerful modulator of the central nervous system. In particular, corticospinal inputs are essential for motor unit recruitment and activation; however, specific strength training parameters are important for neuroplasticity. Strength training that is externally paced and akin to a skilled movement task has been shown to not only reduce tendon pain, but modulate excitatory and inhibitory control of the muscle and therefore, potentially tendon load. An improved understanding of the methods that maximise the opportunity for neuroplasticity may be an important progression in how we prescribe exercise-based rehabilitation in tendinopathy for pain modulation and potentially restoration of the corticospinal control of the muscle-tendon complex.
Patellar tendinopathy : Clinical diagnosis, load management, and advice for challenging case presentations
- Authors: Malliaras, Peter , Cook, Jill , Purdam, Craig , Rio, Ebonie
- Date: 2015
- Type: Text , Journal article
- Relation: Journal of Orthopaedic & Sports Physical Therapy Vol. 45, no. 11 (2015), p. 887-898
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- Description: The hallmark features of patellar tendinopathy are (1) pain localized to the inferior pole of the patella and (2) load-related pain that increases with the demand on the knee extensors, notably in activities that store and release energy in the patellar tendon. While imaging may assist in differential diagnosis, the diagnosis of patellar tendinopathy remains clinical, as asymptomatic tendon pathology may exist in people who have pain from other anterior knee sources. A thorough examination is required to diagnose patellar tendinopathy and contributing factors. Management of patellar tendinopathy should focus on progressively developing load tolerance of the tendon, the musculoskeletal unit, and the kinetic chain, as well as addressing key biomechanical and other risk factors. Rehabilitation can be slow and sometimes frustrating. This review aims to assist clinicians with key concepts related to examination, diagnosis, and management of patellar tendinopathy. Difficult clinical presentations (eg, highly irritable tendon, systemic comorbidities) as well as common pitfalls, such as unrealistic rehabilitation time frames and overreliance on passive treatments, are also discussed.