Tendinopathy

 

Chronic tendon pathology, or tendinopathy, is a prevalent musculoskeletal condition which affects both athletes and non-athletes (Cook and Purdam 2013). It is an overuse injury characterized by localized tendon pain with loading and dysfunction (Malliaras et al. 2013). Currently, the most prevalent model in the research which outlines the stages of tendinopathy is the “Three Stage Continuum Model” put forward by Cook and Purdam (2009). This model incorporates three stages: reactive tendinopathy (tendon attempts to adapt to acute overload); tendon disrepair (tendon reaches this stage if persistent overload continues); and degenerative tendinopathy (unlikely that the tendon will be able to transition back to full repair).

 

The most commonly affected tendons are the achilles, rotator cuff, patellar, and elbow extensor tendons. Unfortunately, it would not be feasible to cover all tendons susceptible to tendinopathic changes in the scope of this short course. With this in mind it was decided to include the two most prevalent tendinopathies in this booklet, namely Achilles and rotator cuff tendinopathies. Regarding Achilles tendinopathy it has been reported that athletes are up to thirty times more at risk of developing this injury than their sedentary counterparts (Brukner and Khan 2007). In a general population, the incidence of rotator cuff tendinopathy ranges from 0.3% to 5.5% and has an annual prevalence from 0.5% to 7.4% (Littlewood et al. 2013). While there is a lack of data on the prevalence of rotator cuff tendinopathy in sporting populations, athletes engaged in sports that involve overhead motions are more susceptible to rotator cuff injury (Scott and Ashe 2006).

 

The management of tendinopathy can be challenging, and research in this area has failed to provide robust evidence for many of the commonly used interventions (Krogh et al 2012, Coombes et al 2010, Woodley et al 2007). However, since it is broadly agreed that there is much yet to be understood about the causes of tendinopathy (Riley 2008), it is perhaps unsurprising that clinical trials including patients with a range of degrees of tendinopathy report equivocal results (Bennell et al 2010). This short course will attempt to present an overview of the evidence and recommend the current best evidence based approach to management of tendinopathy in athletes. This will incorporate information on the risk factors that can predispose the injury, on the treatment protocols that have been appraised in the evidence and on the psychosocial factors that may need to be addressed in the rehabilitation.