Tendinopathy (FS-25)

Tendinopathy rehabilitation and ´tickets´ to treatment

Dylan Morrissey (United Kingdom), Peter Malliaras (Australia), Henning Langberg (Denmark), Alex Scott (Canada)

Focused symposium

Saturday 2 May 2015, 16:00-17:30, Hall 406

Tendinopathy rehabilitation and ´tickets´ to treatment

Morrissey D. 1, Malliaras P. 2, Langberg H. 3, Scott A. 4

1Queen Mary University of London, Sports and Exercise Medicine, London, United Kingdom, 2La Trobe University, Melbourne, Australia, 3University of Copenhagen, Copenhagen, Denmark, 4University of British Columbia, Vancouver, Canada

Learning objectives

  1. Participants will have developed comprehensive awareness of the latest evidence for tendinopathy management
  2. Participants will have explored clinical reasoning for common interventions including exercise, eccentric training, shock wave therapy, injection therapy and load management strategies.
  3. Participants will be able to apply best practice guidelines for managing common tendinopathies based on the material presented and debate from participants

Description

We are in a unique situation in that the world's leading scientific experts within rehabilitation of tendinopathy are physiotherapists. This situation allows us to bring together world experts from the UK, Denmark, Canada and Australia to share the latest evidence and clinical expertise concerning optimal tendinopathy management - from basic science to progressive load management and the integration of evidence-based adjunctive treatments.

Major advances in tendinopathy have recently been realized, including a greater understanding of how mechanical load drives pathology, and an increasing appreciation of pain mechanisms including both peripheral and central nervous system changes. This increased understanding parallels advancement of management strategies including minimally invasive surgery, high volume injection therapy, and shock wave therapy. These are effectively adjuncts to the primary treatment - progressive load management. Exercise management for tendinopathy has also matured, with a move away from the well entrenched eccentric training to a more balanced and progressive loading pathway that is now backed by substantial evidence. The evidence and clinical reasoning underpinning exercise and adjunctive treatments will be presented and explored by clinical academics who have been at the forefront of generating and synthesizing the knowledge advances made in the field.

Rehabilitation through load management has until recently followed prescriptive protocols without adequate consideration of how evidence-based approaches may need to be individualized for different sub-groups and functional demands. We will review and re-interpret the evidence for such protocols and suggest ways in which management can be individualized for optimal effect, incorporating basic science and clinical evidence into a clinical reasoning framework. The key message is that tendinopathy is not a “one size fits all” diagnosis and thorough review and clinical interpretation of the current literature can provide guidance for a more considered, specific approach to rehabilitation. This is a critical message for clinicians as the tendinopathy literature can be difficult to navigate and for any given question (e.g. is foot posture associated with lower limb tendinopathy) there are usually several conflicting answers. A reasoned approach requires consideration not only of the level of evidence and its quality, but also how interventions are tailored to individual patients based on demographics, risk factors, presenting and goal function, pain and specific pathology. The role of adjuncts alongside such tailored interventions should optimize outcomes.

Implications / Conclusions

There has been an explosion of tendinopathy research in the areas of patho-aetiology and management over the last decade. The practice of evidence-based medicine requires an integration of evidence with clinical experience and a consideration of client-centred goals. It is the goal of this symposium to review and extrapolate from the current evidence in order to suggest ways to optimise individual outcomes

Keywords

Tendinopathy; Rehabilitation; Adjuncts to treatment

Funding acknowledgements

not applicable

Relevance to WCPT and expected audience

Tendinopathy is one of the most common problems seen by physiotherapists treating patients with musculoskeletal disorders. Only a small percentage of tendinopathies are directly sports related, the rest developing as part of everyday life and activity but all are typically troublesome and recurrent in any group. The symposium authors are amongst the leaders in the fields of tendinopathy mechanobiology, rehabilitation, adjuncts and knowledge translation - guaranteeing excellent material and an educational event.

Target audience

Widely transferable detail and principles for physiotherapists treating people with any musculoskeletal disorder in any setting, as well as researchers and educators.