Lower Limb Tendinopathy Symposium

Take home messages!

 

The Lower Limb Tendinopathy Symposium, held over September 9th and 10th weekend, hosted by Physiosports Brighton was presented by leading experts in the field of tendons, Jill Cook, Ebonie Rio and Sean Docking from La Trobe Sport and Exercise Medicine Research Centre and the long term head of the Physical Therapies Department at the Australian Institute of Sport, Professor Craig Purdam.

 

The first day focused on updating attendees with the latest research and clinical findings such as new research in tendinopathy, the role of pains sciences in treating tendinopathy,  (1, 2) findings from imaging studies (3, 4) and revisiting the tendon continuum model.(5) The second day combined small group workshops and several case study presentations. After such great presentations, this blog aims to give the reader an enormous amount of tips and tricks in the field of lower limb tendinopathy and aims to share a few clinical pearls gained from the course.

 

Ultrasound Tissue Characterization (UTC) visualizes and quantifies 3-D Tendon Integrity and can discriminate various pathological stages and is highly reproducible and is a relatively new technique. Dr Sean Docking, who researches this area had several key messages;

 

Craig Purdam has many years’ experience in the treatment of hamstring tendinopathy in athletes. From his experience hamstring origin tendinopathy can co-exist with sciatic nerve changes. It is therefore imperative to include both muscle and nerve/neural tests in objective examination.

 

Dr Ebonie Rio has focused her research on the relationship between pain science and tendinopathy. Ebonie has successfully integrated years of clinical experience at the Victorian Institute of sport, Australian Ballet Company and school and Olympic games with teaching and research. Ebonie’s work shop focused on management of Achilles tendinopathy. Key messages included;

 

 

 

Professor Jill Cook went through a useful clinical taping technique that aims to offload the patellofemoral joint (PFJ) and may assist to differentiate pain coming from the PFJ. A diamond shape around the patella is tensioned that is proposed to slightly lift the patella away from the femoral trochlea.

 

 

The Spanish squat exercise, often used in the treatment of patellar tendinopathy, is a great way to load quadricep muscles isometrically. “Don’t use a seat belt, it will be a disaster and it will break.” This particular belt that Professor Cook uses is rated to 1000 kgs. Instructions to patient should include ‘keep body upright, arms by the side and slowly sit down.’ The knee angle should be determined by the individual and be at a point that they feel like they can hold the position for a clinician’s pre-determined time e.g. 45 seconds. Feet should be secure to avoid slipping with the attachment point needing to be onto a sturdy structure designed to handle weight.

 

Written by Zuzana Machotka

 

 

 

References

  1. Rio E, Kidgell D, Moseley GL, Gaida J, Docking S, Purdam C, et al. Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med. 2015:bjsports-2015-095215.
  2. Rio E, Moseley L, Purdam C, Samiric T, Kidgell D, Pearce AJ, et al. The pain of tendinopathy: physiological or pathophysiological? Sports medicine. 2014;44(1):9-23.
  3. Docking S, Cook J. Pathological tendons maintain sufficient aligned fibrillar structure on ultrasound tissue characterization (UTC). Scandinavian journal of medicine & science in sports. 2016;26(6):675-83.
  4. Docking SI, Ooi CC, Connell D. Tendinopathy: is imaging telling us the entire story? journal of orthopaedic & sports physical therapy. 2015;45(11):842-52.
  5. Cook J, Rio E, Purdam C, Docking S. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med. 2016:bjsports-2015-095422.