By: Brett Windsor,
Looking further at the Rees article from yesterday, I had a few additional thoughts that I wanted to pass on:
1. No mention of physical therapy as a modality capable of successfully treating tendinopathy. A lot of valuable physical therapy contributions were overlooked, despite the fact that our profession has contributed an extensive amount to the progression of this problem. Eccentric exercises were mentioned through the Alfredsson study, but no direct link to PT.
2. I'm not sure I agree with the contention that we've completed eliminated the concept of inflammation from the discourse about tendon pathology. I would certainly agree that we were as guilty as anyone with the excessive focus on the inflammatory aspects, but I think we've largely transitioned into a mechanical role with a healthy respect allowing for the possibility of inflammation.
3. No mention in the treatment section of instrument assisted soft tissue techniques...the various methods have garnered some very promising results in the clinical arena and there is some good research beginning to support these claims. Also no mention of the role of manipulation in treatment, for example, Mills manipulation for recalcitrant lateral epicondyle pain.
4. Is it true that the success of eccentric exercise is limited since the Alfredson study? Is that really all we've got?
5. There is a lot of talk about the various biochemical/inflammatory/genetic processes involved with tendinopathy, but no discussion on the trigger. Is it over-stimulation? Under-stimulation? There is a building body of knowledge now beginning to suggest that the primary etiology of tendon pathology is actually under-stimulation. Counter-intuitive in some respects...but, read for yourself below. A very interesting read.
Bottom line...got to be careful about not completely eliminating the possibility of inflammation in tendinopathy, but the primary etiology does appear to be under-stimulation leading to degenerative changes and angiogenesis.
Best regards. Brett