subject: Tendonitis Injuries And Their Rehabilitative Programs [print this page] Injuries to tendons most likely occur when a person begins to engage in an unfamiliar physical activity or suddenly increases the intensity of duration of an activity they have been doing for some time. Because a period of recovery is necessary to meet the increased demands on the tissuesinadequate recovery is thought to lead to breakdown at the cellular level.
A normal response to tendon injury consists of inflammation followed by regeneration and remodelling (strengthening) of the tendon. However, a failed healing response may occurbecause of ongoing mechanical forces on thetendon, poor blood supply, or both. The tendonmay undergo microscopic changes including the deposition of weaker constituents creating disorganized new tissue which is painful and weak.
Patients begin to experience a gradual onset of pain over the affected tendon that worsens with sustained activity. Pain is usually described as dull at rest, and sharp with the aggravating activity. Decreased range of motion of the joint may be seen at the site of injury and there may be tenderness along the length of the tendon.
Tests ordered may include plain X-rays which are usually normal, but may reveal calcification of the tendon, underlying degenerative joint disease, or a loosebody in the joint. Diagnostic ultrasound is also commonly used to check for the health of a tendon. MRI may be used if surgery is being considered.
If symptoms are the result of recent overuse the problem is usually inflammatory and acetaminophen or anti-inflammatory drugs may be prescribed. However, these are not expected to speed recovery from tendon injury and may interfere with that process.2,3,4Acetaminophen and NSAIDs provide short-term painrelief but do not affectlong-term outcomes.
Treatment should always start with protecting the tendon, rest, ice, compression, elevation, medications, and rehabilitative exercise modalities.2,4,6Patients should reduce their level of physical activity to decreaserepetitive loading on the tendon. The durationof rest depends on the injury and thepersons activity level.
Rehabilitative exercises involve a stretching and strengthening program and should be initiated early.Other physical therapy modalities include ultrasound, iontophoresis (electric charge to drive medication into the tissues), and phonophoresis(use of ultrasound to enhancethe delivery of topically applied drugs).
Successful management of tendon injuries aims to reduce overuse of the tendon, correct training errors, stop smoking,and using correct shoes that are not appropriate for thespecific activity.Orthotics, such as inserts or a heel-wedge are sometimes used to help unload, reinforce, and protect the tendon.
Because many of the standard therapies for tendinonshave failed to consistently correct the underlyingdegenerative process, many new treatments are beingdeveloped, the effectiveness of which is currently being investigated.
Surgery should be considered only if a comprehensive,nonsurgical treatment program of three to six monthshas failed, or if rupture of the tendon isevident. Surgery involves excising the abnormal tendonand releasing areas of scarring and fibrosis.
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