Issue link: https://www.massageandbodyworkdigital.com/i/1208028
Ta k e 5 a n d t r y t h e A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 95 Tendinosis In the mid-to-late 1980s, several research studies were published indicating that many chronic overuse tendon pathologies did not appear to involve inflammatory cells. This research showed that chronic overuse tendon disorders were likely caused by degeneration of the collagen matrix within the tendon and not from tendon fiber tearing with an inflammatory reaction. As a result of the studies, the term tendinosis (-osis meaning pathology) became more widely used. More recent research has suggested that there still may be some inflammatory activity, especially in the very early stages of a tendon disorder, so the concept of non-inflammatory overuse tendon pathologies is still somewhat debatable. Tenosynovitis Certain tendons, especially those in the distal extremities that course around sharp angles, are covered in a synovial sheath (Image 2). If a tendon doesn't have to manage high friction forces, it is generally not enclosed in a synovial sheath. Friction during repetitive activity can cause an inflammatory reaction between the tendon and the surrounding synovial sheath. There may also be some fibrous adhesion between the tendon and the surrounding sheath. The fibrous inflammatory reaction between the tendon and its sheath is called tenosynovitis. CAUSES OF OVERUSE TENDON PATHOLOGY There are a number of potential causes of chronic overuse tendon pathology. The most common is repetitive loading. Certain tendons are far more susceptible to repetitive loading injury than others. Repetitive loading usually refers to repeated pulling on the tendon from recurring muscular contractions. However, recent studies have suggested that chronic compressive loads on tendons may be a primary factor for tendon pathologies as well. 1 Due to their anatomical arrangement, certain tendons may be susceptible to compressive forces as the tendon bends around a bony prominence. When its associated muscle contracts, the tendon is pulled tighter against the bone, causing increased compressive load on the tendon. It is relatively easy to understand why specific mechanical forces on the tendon can lead to overuse disorders. However, other factors also appear with some frequency in people with various tendinopathies. It's not clear why, but obesity, alcoholism, systemic disorders, and various genetic factors also appear with regular frequency in people suffering from tendinopathy. 2 Certain medications are also known to cause tendon disorders. For many years, it was standard practice to prescribe corticosteroids for chronic overuse tendon problems because they were perceived to be an inflammatory problem. Corticosteroids are very effective at managing inflammatory disorders. However, extensive research around corticosteroids has shown that they have long-term detrimental effects on collagen regeneration, so while they are very effective at pain reduction, they may be harmful in the long term for healing of the damaged tendon tissue. Another important group of medications known to cause tendon problems are the family of antibiotics called fluoroquinolones. The use of these antibiotics is an essential factor to pick up in the client history even though it may seem unrelated. Fluoroquinolones inhibit fibroblast metabolism that is necessary for tendon regeneration. 3 Clients may often be taking this group of antibiotics for conditions such as respiratory infections, and then develop some chronic overuse tendon pathology without knowing the correlation between the two. ASSESSMENT The degree of pain felt in tendon disorders is not always consistent with the degree of damage or dysfunction in the tendon tissue. That can make identifying tendon disorders at different stages more challenging. However, there are several consistent patterns during assessment with most overuse tendon pathologies. The chart on page 96 helps you recognize how various forces on the tendon are evaluated during simple range-of-motion evaluations. Active Shortening Tendons don't actually shorten, so the term active shortening refers to the associated muscle. There is a load on the tendons during active movement, so when a tendon pathology is severe enough, this action usually produces pain. However, for some overuse tendon disorders, the amount of load in an active range-of-motion evaluation may not be enough to cause pain because the tensile load is not significant enough. Tendon sheaths surrounding extensor tendons 2 Synovial sheaths surrounding tendons in the distal extremities. Image from 3D4Medical's Complete Anatomy application. Watch "Active Stripping Elbow Flexors"