Tendinopathies

 

Definition - Tendon

A tendon is a strong, fibrous collagen-type tissue  (also referred to as “connective tissue”) that attaches a muscle to a bone.

Definitions - Tendinopathy

Tendinopathy refers to injury of a tendon due to repetitive loading of the tendon.

Symptoms of a tendonopathy  are:

  • pain
  • decreased exercise tolerance of the tendon
  • decreased function

 

Tendon pathology is divided into three stages namely: 

  1. reactive tendinopathy, 
  2. tendon disrepair and 
  3. degenerative tendinopathy.

 

Let’s discuss each phase individually.

1.  Reactive Tendinopathy

Reactive tendinopathy typically involves the tendon responding to a rapid increase in load (for example in runners this means and increases in mileage, less resting days or a change in training type) or as a result of  direct trauma to the tendon. 
In this phase there is no inflammation. 
Reactive tendinopathy usually happens in young active individuals who experience it for the very first time.

The structures in this phase remain intact in other words there is a minimal change in the collagen integrity.

Summary  -
Reactive tendinopathy is a short-term adaptation to overload that thickens the tendon, decrease s its ability to withstand stress and increases the tightness of the tendon. A tendon in the reactive phase has the potential to return to normal if the load is sufficiently reduced or sufficient time of rest between the loading sessions is allowed.

Advice  -
Usually patients may continue with movement that is low in impact.

 2.  Tendon disrepair

Tendon disrepair is a progression of reactive tendinopathy and occurs when the tendon is not offloaded and allowed to heal. 
In this phase there is more cellular breakdown than in the reactive phase.

Tendon disrepair usually happens in the chronically overloaded young athletes.

Summary -
In the phase the tendon is thickened but there is still a possibility to reverse the damage to the tendon with the correct load management and exercises.  

 3.  Degenerative tendinopathy 

In degenerative tendinopathy the changes in the tendon is irreversible as there is even more cellular breakdown than in disrepair phase.

Typically this type of tendon is found in older individuals who struggled for long periods with tendinopathy or younger individuals who have continued with overloading the tendon.

Summary -
The tendon is thickened and can present with palpable nodular sections.

 

Exercising in winter


There’s just something about the cold weather that really can place a damper on one’s exercise routine. 

But consider this - 
Indirectly, exercise improves mood and sleep, and reduces stress and anxiety. Problems in these areas frequently cause or contribute to cognitive impairment.” (Harvard Health Publishing, 9 April 2014)

 

If you find that you are struggling to find inspiration to get moving this winter, here are some suggestions:

  • invite a friend to join you for a walk/workout, you are much more likely to go for the walk when you know a friend is waiting for you at your starting point
  • working in and around the house warms you up and burns some calories as you go
  • keep your exercise/physical goals in mind - write out a reminder or make a picture board of your goals and place it where you can see it regularly
  • rather than skipping your workout completely, try adjusting your routine to something less strenuous so that you still do some exercise (in stead of doing nothing at all)
  • if all else fails, go for a walk in the mall, although perhaps just a little faster than a stroll:)

 

If you need any advice, ask your physiotherapist to assist you with a home exercise program using
basic equipment such as a mat and a gym ball. 

 

 

 

 

 

RSV - quick facts

Most moms have heard of, or have first hand experience ,with RSV.
Here are some quick facts:

  • RSV, or Respiratory Syncytial Virus, is a virus that affects the airways and lungs. 
  • RSV is highly contagious and is spread via droplets (sneezes, coughs).
  • RSV causes symptoms like that of a common cold, e.g.
    • stuffy or runny nose
    • fever
    • coughing
    • headaches
  • In a small amount of children RSV may lead to bronchiolitis or pneumonia.
  • Smaller children, especially those who were born prematurely, are usually affected more than bigger children.
  • While most kids will have had a RSV infection by age 2, lets help prevent its spread by remembering to
    • wash our hands,
    • cover our mouths and noses when we cough
    • keep surfaces clean

Phases of healing

 

Soft tissue injuries go through 3 phases en route to recovery:

  1. Inflammatory phase
  2. Fibroblastic/Proliferation phase
  3. Remodelling phase.

 

Let’s discuss each phase -
(remember that injuries differ and that the times stated below are guidelines so do overlap with each other)

 

  1. Inflammatory phase

When soft tissue structures (muscles, ligaments etc.) are torn during an injuring event, blood vessels may also be damaged and localized bleeding will occur.
Blood vessels respond to trauma by narrowing their diameter (known as ‘vasoconstriction’), slowing bleeding and allowing the opportunity for a blood clot to form. The blood clot “plugs” the ruptured blood vessels at injury site.

About an hour after the injury, blood vessels start to widen their diameter (known as ‘vasodilation’), to allow the influx of various inflammatory cells, antibodies etc. to the area. These cells are the clean up crew of the injury’s debris and the builders of new muscles cells.
[Phagocytes, for example, are cells that are directed to the injury site and act as antibodies that destroy bacteria and dead cells from the area.]

Even though the inflammatory phase is still very early in the healing process, the laying down of collagen (the protein building blocks of muscles) is initiated here. 
[The type of collagen laid down in the inflammatory phase is not as strong as the type of collagen of the Proliferation phase.]

What to expect:
During the inflammatory phase you will experience more pain than in the other phases. The reason for this is the chemical irritation of the nerve endings by the swelling and bleeding at the site of injury. 

Time line:
The inflammatory phase is set in motion by the injury and can last up to 6 days. In some cases it can last up to two weeks.

 

  1. Fibroblastic/Proliferation Phase 

The proliferation phase is also known as the repair phase. 
It is in this phase that “wound contraction” happens, i.e. the wound starts closing as the margins of muscle fibres are pulled together. 
The most important aspect of this phase is that lots of collagen (protein building blocks) is being laid down, and more collagen means increased tensile strength of the muscle fibers at the injury site. 
[Tensile strength refers to the resistance the muscle fibers have to being torn.]

Time line:
The proliferation phase can start as anywhere from between the fourth day after injury to 2 - 3 weeks after the injury. In some cases this phase can last 2 -1 2 weeks.

 

  1. Remodelling phase 

The remodelling phase is the last of the 3 phases of healing. 
In this phase the collagen that was laid down in the proliferation phase is being matured and the final orientation and alignment of collagen fibres is completed.
At the end of this phase, muscle tissue’s integrity and strength starts to returned to normal but is still vulnerable. Careful loading of the previously injured tissue is advised.

Time line:
The remodeling phase can range from 2 - 4 weeks after injury, and can last up to 6 - 12 months post injury.

Glut Medius, WE LOVE YOU

In the past 2 or 3 months, we have seen quite a few patients at the practice that, on evaluation, presented with weakness of the Gluteus Medius muscle. These patients’ main complaints were not pain in the Gluteus Medius muscle but more often complain of “runner’s knee” (also known as patella femoral pain syndrome/PFPS) or pain in the achilles tendon region.

This previously-neglected-now-much-talked-of muscle is, as millennials say, “the bomb” when it comes to rehab of the lower limb. Thus we give Glut Medius centre stage in this blog.

 Let’s take a look at some facts:

 Gluteus Medius is one of the three bilateral (one on each side of the body) buttock muscles essential to gait. Together they are the main movers when moving one’s leg backwards and to the side.

 

Origin and insertion

Gluteus Medius is a fan-shaped muscle that arises from the rim of the pelvis and inserts on the greater trochanter of each femur (that bony bump on the outside of you upper thigh bone).


Nerve supply

Both Gluteus Medius muscles are innervated by the Superior Gluteal nerve which is a branch of the large sciatic nerve.

     

Function
During walking, Gluteus Medius has the very important function of keeping the pelvis level (Moore). This allows one leg to stand securely on the ground while the other can swing forward to take a step.

Gluteus Medius also

  • brings the leg out sideways
  • does both inward and outward rotation of the leg, depending on which part of the muscle is being activated.

[If the front part of Gluteus Medius is active, it assists with inward rotation of the leg, as well as with forward bending of the hip. When the back part of the muscle is active, it assists with outward rotation of the leg and extending the leg backwards.]

 

Clinical significance
Gluteus Medius’ role in pelvic stability during gait, makes them important muscles for good, painfree gait.

Why strengthen? Think

  • improved lower limb balance 
  • improved lower limb control
  • greater muscle power 
  • greater muscle endurance
  • pain relief
  • injury prevention

 

Quicktest
We use a forward lunge to do a functional screening for weakness of the Gluteus Medius. 

How
Start standing upright with enough space to lunge forwards. Give a large step forward into a lunge and step back into starting position. 

Repeat a few time on each leg.

Key points
As the Gluteus Medius controls rotation of the leg as well as providing stability around the hips, watch for inward roll of the knee. A weaker Glutues Medius will be unable to keep the lunging leg’s knee cap facing forward. 

 

Exercises
Here are a few of our with favourites -

Running man
Stand with your back against wall, take a large step forward. 

Bend one knee and put your foot on the wall behind you, the other leg remains weight-bearing
(the weight-bearing leg is going to be doing most of the work). 

Mimic the motion of running by bending and straightening your weight-bearing knee, remember to add arm movements.

Clamshell
Position yourself lying on your side, hips and knees bent about 45 degrees, ankles stacked together.

Keep your feet together and lift your top knee to hip height. When lifting the top knee, don’t roll your pelvis backwards, keep the hip bones aligned

Wide stepping
Tie stretch band around your ankles.

Using very large steps, walk sideways for 10m, e.g. leading with you right leg. Return to your starting position but know lead with your left leg. Repeat 2 - 3 times.