MDNews - Greater Kansas

+++++++++++++++++++++++++ + + +++++++++++++++++++++++++ PHYSICAL THERAPY Tendinitis vs. Tendinosis Physical Therapy WE & +++ +++ 12 | Greater Kansas MD NEWS MDNEWS.COM K N OW T H AT TENDINITIS i s inf lammat ion of a tendon. Tendinosis is a less common diagnosis, but probably more prevalent. Tendinosis is the degeneration of the collagen elements of the tendon. When a patient presents with chronic tendon pain in the Achilles, elbow, patellar tendon or hamstring, it is important to consider the possibility of tendinosis. Karim M. Khan, M.D., suggests many tendinopathies may be tendinosis and that the current concept of treating them as infl ammatory conditions may be an inappropriate way to look at these problems. He suggests that tendi- nosis is often chronic, lasting more than six months. Dr. Khan classifies the tendinosis condition as follows: "Intratendinous degeneration commonly due to aging, microtrauma, or vascular compromise, collagen disorientation, disorganization, and fi ber separation by increased mucoid ground substance, increased prominence of cells and vascular spaces with or without neovascularization, and focal necrosis or calcifi cation." This is contrasted with tendinitis, which Dr. Khan describes as: "Symptomatic degeneration of the tendon with vascular disruption, infl ammatory repair response, degenerative changes with superimposed evidence of tear, including fi broblastic and myofi broblastic proliferation, hemorrhage, and organizing granulation tissue." Physical therapy can help the tendinosis patient. Eccentric loading (placing a muscle under load while it lengthens) has been well-researched and shown to clini- c h r o n i c conditions. In addition, p a t i e n t s c a n b e taught how to perform eccent r ic strengthen- ing on their own as part of a home e x e r c i s e program. Ideally, the sooner treatment can begin, the lesser the chance of the condition becoming more chronic and the sooner the patient can return to activity without pain. Cody Barnett, P.T. is in private practice in Cody Barnett, P.T. cally relieve the symptoms of tendinosis and assist in return to function. Håkan Alfredson, M.D., et al, demonstrated the value of eccentric loading with Achilles tendinosis, and Holmich, et al, described the benefi cial effects of active therapy with chronic hip adductor problems. Similar clinical experiences have been noted with chronic hip abductor tendinopathy as well. In particular, eccentric loading using an isokinetic dynamometer has been well-documented in the treatment of tendinosis. Clinically, Bodyworx Physical Therapy uses an isokinetic dynamometer regularly with these diag- noses and has found isokinetic use to be crucial in helping these frustratingly Wichita, KS. He specializes in the treatment of orthopedic and musculoskeletal injuries with a special emphasis in lower body biome- chanics, pediatric and adult sports injuries, and neck and back pain. He may be reached at www.BodyworxPhysicalTherapy.net or (316) 558-8808. ■ References Khan KM, et al. Overuse tendinosis, not ten- dinitis. Phys Sportsmed 2000, May; 28(5):38-48 Khan KM, et al: Histopathology of common tendinopathies: update and implications for clini- cal management. Sports Med 1999; 27(6):393-408 Alfredson, et al: Heavy-load eccentric calf muscle training for the treatment of chronic achilles tendinosis. Am J Sports Med 1998; 26(3):360-366 Holmich P, et al: Effectiveness of active physical training as treatment for long-standing adductor- related groin pain in athletes: randomised trial. Lancet 1999; 353(9151):439-443 Croisier JL, et al: Treatment of recurrent tendinitis by isokinetic eccentric exercises. Isokinet Exerc Sci 2001; 9:133-141

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