Tendinopathy

Patellar tendinopathy is characterised by localised anterior pain and is related to an increase load on the knee extensor muscles.  Achilles tendinopathy is a common overuse injury caused by repetitive energy storage and release with excessive compression.

Treatment should be individualised to each patient and their activities. It is important as a clinician to understand the pathology and the evidence-based practice for rehabilitating a person with tendon pain. The course will provide you with an overview of the pathology and different therapeutic approaches and different clinical presentations of patellar versus Achilles tendinopathy. The medical and physiotherapy management of these conditions will be discussed.

This e-Learning course summarises the tendinopathy continuum and articulates the authors' clinical reasoning and hands-on experience managing Achilles tendinopathy. We outline graded loading concepts while emphasising that relying on recipes is likely to fail. We also provide a perspective on the role of central pain processing and peripheral input from nociceptive fibres in the context of tendinopathy. 

Rehabilitation should be tailored to address identified impairments (muscle bulk asymmetries, kinetic chain dysfunction, tolerance of energy storage and release in the Achilles tendon), and progressively work toward movements and activities relevant for the individual's sport or daily activities.

Gareth Devine - MSc (Wits) Med Biokinetics; BAHons (Wits) Phys Ed; Sport Science and Biokinetics (UJ); PGCE (Wits) 

Tendinopathy is a clinical diagnosis of pain and dysfunction in a tendon. It most commonly affects athletes from adolescence through to the fourth decade of life. This condition affects health and quality of life by limiting sports and activity participation for recreational athletes and can be career-ending for professional athletes. Once symptoms are aggravated, activities of daily living are affected.  

Tendinopathy clinically presents as localised pain at the proximal or distal tendon attachment to bone with high-level tendon loading, such as jumping and changing direction. It is commonly clinically diagnosed in conjunction with imaging (ultrasound or magnetic resonance where structural disruptions on the scans represent areas of tendon pathology. Importantly, there is a disconnection between pathology on imaging and pain; it is common to have abnormal tendons on imaging in people with pain-free function.

Treatment of tendinopathy may involve prolonged rehabilitation and can ultimately be ineffective. Management is limited by a poor understanding of how this condition develops, limited knowledge of risk factors and a paucity of time-efficient, effective treatments. This webinar discusses the prevalence of tendinopathy, associated and risk factors, assessment techniques and treatment approaches that are based on evidence where possible, supplemented by expert opinion. This webinar utilizes videos of practical rehabilitation.