Various physical therapies in TENDINOPATHY Jakub Jeníček.
-
Upload
jayson-black -
Category
Documents
-
view
215 -
download
1
Transcript of Various physical therapies in TENDINOPATHY Jakub Jeníček.
Various physical therapies
in
TENDINOPATHY
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 of treatments
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
1. dose 20 J/cm2, continuous frequency do deliver energy to the tissue
2. dose 10 J/cm2, pulsed frequency to modulate desired effect
structure modification and healing shockwave therapy – optimum 2 bar in pathologic spot,
2000 pulses with frequency 10 - 15 Hz
14
Thank you for your attention!