naiomt-blog-feature-800-color.jpg

Continuing to Revisit inflammation in the tendons...

Posted by NAIOMT on Nov 6, 2014 4:38:24 PM

By: Brett Windsor,

image11

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.

http://onlinelibrary.wiley.com/store/10.1111/j.1365-2613.2007.00548.x/asset/j.1365-2613.2007.00548.x.pdf?v=1&t=i26mihlv&s=b8f4acd6b9c0cdab6df910663e5313669e8a3a1d

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

Topics: Uncategorized

NAIOMT Course Schedule

Get an overview of all upcoming courses. Click the headlines to sort by course title, location, instructor or start date.

FIND YOUR COURSE

 

NAIOMT Course Locations

Access local course schedules and instructor videos.

NAIOMT Course Registrations

Registration for all NAIOMT's courses, tests and exams are now done through the industry-leading event registration platform Eventbrite. To register, simply go to NAIOMT's Eventbrite page at www.NAIOMT.Eventbrite.com to view all upcoming courses, tests and exams.

GO TO NAIOMT's EVENTBRITE PAGE

Subscribe to Email Updates

Recent Posts

Posts by Topic

see all