Saturday, 8th February 2025 registration 8:30 a.m (GMT)

 

We’re excited to announce our new one-day course in collaboration with the fantastic team at Physiquipe:

 “Tendinopathy Masterclass” 

 

After a highly successful 2024 with 6 sold out events it’s time to plan ahead for 2025. Mark your calendars on Saturday, February 8th, 2025, as we gather at the impressive Manchester Institute of Health & Performance (MIHP) for a multidisciplinary, in-depth, hands on exploration of tendinopathy in both the upper and lower limbs, with a special focus on the Achilles, patella tendons, and the rotator cuff. 

 

This is going to be an event not to miss as we have not one but five! highly experienced speakers from the Simply MSK team in Carl Clifford (TheKneePhys), Damian Buck, Dr Alastair Jones (TheSportsInjuryDoctor), Matt Walmsley (Physio_offthecuff) and Dr Michael Cooke.

 

Who Is This Event For? 

This event is open to all healthcare professionals who assess and manage tendinopathy conditions. This may include but is not limited to physiotherapists, sports medicine doctors, sports therapists, sports rehabilitators, emergency nurse practitioners, podiatrists, strength and conditioning practitioners.

 

Why Should I Attend?

If you are a clinician who deals with tendinopathy in clinical practice and you have a hunger to broaden and improve your knowledge, skills and confidence, making your life easier all the while improving  your results with patients, then this course is absolutely the one for you!

 

You will learn how to:

• Understand the pathoanatomy of tendinopathy including key risk factors in the development of this debilitating injury

• Appreciate the roles of the wider multidisciplinary team and when to appropriately contact/liaise/refer

• Appropriately and effectively assess for tendinopathy, differentiating against common pathology that mimics symptoms, including the use of imaging with live demonstrations

• Effectively treat and rehabilitate this stubborn condition including tricky chronic cases, with demonstration on the use of shockwave therapy

• Understand the best objective measures to assess progress and set specific goals, including the use of ForceDecks and Dynamometry.

• Ultimately make your life easier by mastering tendinopathy whilst achieving better results with your patients

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Tendinopathy Background

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Tendinopathy is a term used to describe a range of tendon disorders characterized by pain, swelling, and dysfunction. It often arises from tendon degeneration due to repetitive loading or overuse but can also result from a variety of other factors, including aging, injury, or underlying systemic conditions. The term "tendinopathy" is preferred over "tendinitis" because it reflects the fact that most cases involve degeneration of the tendon rather than active inflammation.

Tendons are thick bands of connective tissue that attach muscles to bones, enabling movement and the transfer of force. Tendons are composed of collagen fibers that are tightly packed in a parallel arrangement, designed to withstand tensile (pulling) forces. However, tendons have limited blood supply and are slow to heal, which makes them vulnerable to overuse and injury. Chronic or excessive loading can lead to micro-tears, poor healing, and tendon degeneration, which are characteristic features of tendinopathy.

While tendinopathy was once thought to be primarily an inflammatory condition, more recent research shows that it is largely a degenerative process characterized by collagen disorganization, matrix degradation, and an increase in cellular activity, such as the presence of tenocytes (the tendon cells) that show abnormal behavior. The condition is sometimes described as "tendinosis" when the degeneration is prominent, while "tendinitis" is less commonly used, as it implies inflammation, which is not always present in chronic cases.

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Pathophysiology

Tendinopathy is believed to occur through a combination of mechanical overload and insufficient repair. The repetitive or excessive stress on the tendon exceeds its natural healing capacity, leading to micro-tearing of the collagen fibers. Over time, the tendon undergoes a degenerative process where the collagen becomes disorganized, and the tendon's ability to resist stress is compromised.

Key features of tendinopathy include:

1. Collagen Degeneration: The collagen fibers in the tendon lose their normal structure, leading to disorganisation and a weakened tendon.

2. Tendon Thickening: As part of the degenerative process, the tendon may become thickened or enlarged, particularly in response to the stress it endures.

3. Neovascularisation: In response to repeated injury, new blood vessels may form in the tendon. These vessels are often fragile and can contribute to pain and further degeneration.

4. Cellular Changes: An increase in the number of tenocytes (tendon cells) occurs, which show abnormal morphology and behavior, contributing to the breakdown of tendon structure.

5. Matrix Breakdown: The extracellular matrix (the "glue" that holds collagen fibers together) breaks down, weakening the tendon and reducing its tensile strength

 

Common Sites Affected by Tendinopathy

Tendinopathy can affect any tendon in the body, but the most commonly affected tendons include:

• Achilles Tendon: The most common tendon involved in tendinopathy, often seen in athletes or individuals who suddenly increase physical activity. It’s frequently associated with running, jumping, or prolonged standing.

• Patellar Tendon (Jumper's Knee): Affects the tendon connecting the kneecap to the shin bone. Common in athletes who engage in sports that involve repetitive jumping and running.

• Rotator Cuff Tendons: Common in overhead athletes (e.g., baseball players, swimmers) and individuals with poor posture or overuse of the shoulder.

• Lateral Epicondylitis (Tennis Elbow): Affects the tendons on the outer side of the elbow and is common in individuals who engage in repetitive wrist and forearm movements, like tennis players, painters, or carpenters.

• De Quervain’s Tenosynovitis: A condition affecting the tendons of the thumb and wrist, often seen in individuals who perform repetitive gripping motions, like typing or lifting.

• Posterior Tibial Tendon: Common in individuals with flat feet or those involved in running or walking, often leading to arch pain and instability.

 

Clinical Challenges in Managing Tendinopathy

Despite being a common musculoskeletal issue, tendinopathy presents several clinical challenges, both in diagnosis and treatment. These challenges include:

 

1. Accurate Diagnosis

• Non-specific Symptoms: The symptoms of tendinopathy can be similar to other musculoskeletal conditions, such as muscle strains, bursitis, or ligament injuries. Pain, stiffness, and reduced function are often the primary complaints, making it difficult to differentiate tendinopathy from other potential causes of musculoskeletal pain.

• Gradual Onset: Tendinopathy usually develops insidiously, with symptoms starting as mild discomfort that progressively worsens over time. This slow onset can lead to delays in diagnosis and treatment.

• Imaging Limitations: While ultrasound and MRI can show signs of tendon degeneration, they do not always correlate well with the severity of symptoms. For example, a tendon that appears significantly degenerated on imaging may not always cause symptoms, and conversely, a tendon with mild degenerative changes can be highly symptomatic. This makes imaging an imperfect tool for assessing tendinopathy.

 

2. Treatment Options and Decision-Making

• No One-Size-Fits-All Solution: Tendinopathy treatment must be individualised based on factors such as the tendon involved, the severity of symptoms, the patient’s activity level, and any underlying conditions. While the standard approach often includes rest, physical therapy, and eccentric strengthening exercises, responses to treatment can vary widely. There is no universally accepted treatment protocol, and clinicians often have to experiment with different interventions.

• Rest vs. Activity: One of the primary challenges is balancing the need for rest with the importance of maintaining activity. Excessive rest may lead to deconditioning of muscles and further impairment of tendon healing, while continued activity may aggravate the tendon and hinder recovery. Active rehabilitation strategies that allow for controlled loading of the tendon are often preferred, but they require careful management.

• Mode of Exercise: Eccentric loading (lengthening of the muscle while it is under tension) has long been thought of as the most effective mode of loading in treating tendinopathy, especially in the Achilles and patellar tendons. However, in recent years studies investigating isometric and concentric work has also shown promising results. Some clinicians struggle with understanding what type and how to implement loading programmes, determining the correct intensity, volume, and progression of exercises to maximise effectiveness without risking overuse or re-injury.

• Conservative vs. Invasive Interventions: In cases where conservative treatment fails, clinicians must decide when to proceed with more invasive options, such as corticosteroid injections, GTN, platelet-rich plasma (PRP) therapy, or, in severe cases, tendon surgery. There is ongoing debate about the efficacy of these treatments, and clinicians must weigh the potential benefits and risks carefully.

• Management of Chronic Tendinopathy: Chronic tendinopathy, especially when it becomes degenerative, is often resistant to traditional treatment methods. This creates a challenge in managing long-term symptoms and achieving meaningful functional improvement. A multidisciplinary approach is often necessary for these cases.

 

3. Understanding Tendon Biology and Healing

• Slow Healing Process: Tendons are relatively avascular (have low blood supply), which means they heal slowly. This is one of the reasons tendinopathy can be so persistent. Clinicians must understand the biology of tendon healing to set realistic expectations with patients and to optimise treatment strategies.

• Load Management: One of the cornerstones of tendinopathy management is understanding how much load the tendon can tolerate without aggravating symptoms. Clinicians must be adept at advising patients on load management—determining when to push the tendon to recover and when to back off to avoid exacerbation. This often involves a gradual return to activity, with careful monitoring of symptoms.

 

4. Psychosocial Factors

• Chronic Pain: Patients with chronic tendinopathy often experience significant pain, which can affect their mental health. Anxiety, frustration, and depression can be common in individuals who struggle with persistent tendon pain that limits their activity. Addressing psychosocial factors and providing appropriate pain management is crucial in these cases.

• Patient Adherence: The effectiveness of conservative treatment is highly dependent on patient adherence, especially with rehabilitation exercises. Clinicians often struggle with motivating patients to stick to prescribed exercise programs, especially when progress is slow or the pain persists.

 

Conclusion

Tendinopathy is a complex, multifactorial condition that presents challenges for both clinicians and patients. Effective management requires a comprehensive understanding of tendon biology, individualised treatment strategies, and careful monitoring of progress. Clinicians often face difficulties in diagnosing tendinopathy accurately, managing the balance between rest and activity, and addressing the wide variation in treatment responses. A tailored, evidence-based approach, combined with an understanding of the patient's unique situation and needs, is crucial to improving outcomes.