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94 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 2 0 technique CLINICAL EXPLORATIONS Exploring Tendon Disorders By Whitney Lowe the tendon to be strong and resilient than for it to be pliable. Consequently, there is a higher concentration of collagen than elastin within tendon tissue. The primary function of tendon tissue is to transmit the muscle's contractile force to the bone. Some tendons carry a much higher tensile load than others. For example, the proximal tendon attachment of the latissimus dorsi is across the wide expanse of the lumbodorsal fascia (Image 1). That means the pulling power of the muscle spreads across all those fibers that eventually blend in with the lumbodorsal fascia. The design of this tendon results in less load on each strand. The Achilles tendon structure has a very different story. The tendon itself is a round and pencil-like tendon attaching to the calcaneus. The gastrocnemius and soleus muscles transmit their powerful contraction force through the Achilles tendon. However, the individual tendon fibers must handle greater tensile loads in this case, as the force is transmitted through a smaller-diameter tendon. Constant high-force loads are one reason chronic overuse pain conditions of the Achilles tendon are so common. UNDERSTANDING TENDON PATHOLOGY There are three primary tendon disorders caused by chronic overuse, but the distinction between them can sometimes get a little murky. Clinicians often use the term tendinopathy when referring to these disorders. Tendinopathy simply means pathology of the tendon. Let's take a look at the three types of tendon disorders. Tendinitis The most common name used for chronic overuse tendon pathologies is tendinitis (also spelled tendonitis). This condition is considered an inflammatory disorder, and thus has the -itis suffix. Previously, it was thought that the primary pathology occurring in tendinitis was tearing of the parallel collagen fibers and subsequent inflammatory response. However, recent research has indicated that this is not a typical scenario, even though it can occur. There is still a fair amount of debate in the scientific literature about whether chronic overuse tendon disorders are inflammatory. However, it is accurate to say inflammatory activity in chronic overuse tendon disorders appears much less common than we used to believe. Latissimus tendon The large and flat tendon of latissimus dorsi. Image from 3D4Medical's Complete Anatomy application. 1 Painful tendon disorders are highly prevalent today and are most often associated with chronic overuse. Numerous other factors can also lead to these conditions. In this installment, we'll take a look at crucial elements of tendon structure and function, and examine common causes of tendon pain so we can best help our clients. TENDON STRUCTURE AND FUNCTION Tendons are composed of dense fibrous connective tissue primarily oriented in parallel strands that are composed of collagen and elastin. Collagen mainly gives the tendon its strength and resilience, and elastin provides the tissue with slight pliability. It's more important for

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