What is Tendonitis?
Tendinopathy is a failed healing response of the tendon, with a haphazard proliferation of tenocytes, intracellular abnormalities in tenocytes, disruption of collagen fibers, and a subsequent increase in a noncollagenous matrix.
What are the causes of Tendonitis?
Tendinopathic tendons have an increased rate of matrix remodeling, leading to a mechanically less stable tendon that is more susceptible to damage. Histological studies of surgical specimens from patients with established tendinopathy consistently show either absent or minimal inflammation. They generally also show hypercellularity, a loss of the tightly bundled collagen fiber appearance, an increase in proteoglycan content, and commonly neovascularization. Inflammation seems to play a role only in the initiation, but not in the propagation and progression, of the disease process.
Failed healing and tendinopathic features have been associated with chronic overload, but the same histopathological characteristics also have been described when a tendon is unloaded: stress shielding seems to exert a deleterious effect. Unloading a tendon induces cell and matrix changes like those seen in an overloaded state and decreases the mechanical integrity of the tendon.
How can physiotherapy help treat Tendonitis?
In general, it would be reasonable to treat a patient with tendinopathy with physical therapy involving a program of eccentric exercises, to be performed for twelve weeks. If the condition does not respond to this intervention, shock wave therapy or a nitric oxide patch might be considered, although data on their efficacy are limited. The use of operative treatment should be discussed with the patient after at least three to six months of nonoperative management. Moreover, patients should understand that symptoms may recur with either conservative or operative approaches
Corticosteroids improve short-term outcomes but are worse than no intervention or physiotherapy for intermediate- and long-term outcomes for some types of tendinopathy.
The developing of a physiotherapy program is very important in the management of the patient. This program can include:
- Eccentric exercises
- Extracorporeal Shock Wave Therapy: Extracorporeal shock wave therapy to address the failed healing response of a tendon is becoming more widely used among the medical community.
- Low-level laser therapy (LLLT)
- Friction massage
- The only areas where an ultrasound showed slight promise was in the treatment of lateral epicondylitis and calcific tendinopathy of the supraspinatus, some controlled trials and a systemic review demonstrated a benefit of using therapeutic ultrasound.
- Therapeutic ultrasound is commonly used in the treatment of tendinopathy. Despite this, there is little clinical research documenting the efficacy of ultrasound in treating tendinopathy or promoting tendon healing.
Consideration of exercise programme:
Eccentric exercises have been proposed to promote collagen fiber cross-link formation within the tendon, thereby facilitating tendon remodeling.
The basic principles in an eccentric loading regimen are unknown, although it has been speculated that forces generated during eccentric loading are of a greater magnitude than those in concentric exercises. It is possible that eccentric exercises do not just exert a beneficial mechanical effect, but also act on pain mediators, decreasing their presence in tendinopathic tendons. Excellent clinical results have been reported both in athletic and sedentary patients.