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Pattelar tendenitis
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Pattelar tendenitis - April 28, 2008 7:27:17 PM
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Christopher Selbie
Posts: 1
Joined: April 28, 2008
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Hello, I am a dancer who suffers from pattelar tendinitis. I have had it for a little over 2 years now and it is slowly getting worse. I am semi professional at this point but my tendinitis really holding back my career. I was hoping that some of you may have suggestions for treatment. I currently take a regular dosage of anti inflamatorys and ice it as often as possible. I have gone to some physical therapists and been shown stretching and strengthening exercises but they dont help. If I rest it for a few weeks it will recover to the point where there is no pain in my daily life, but when I begin dancing again it will start aching within a few days. Any input would be greatly appreciated!
Sincerely,
Chris
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RE: Pattelar tendenitis - April 28, 2008 9:57:21 PM
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jlharris
Posts: 465
Joined: April 12, 2006
From: Nebraska
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Chris,
The first thing you should understand is that tendinitis does not last 2+ years. It may have been tendinitis at first, but now it is likely (and w/o seeing you, evaluating you, or touching you, this is just an educated guess) a tendinosis. What's the difference? Tendinitis is an inflammatory process and tendinosis is a histological change in the tendon itself leading to chronic pain.
Here are some articles with information on treatment for patellare tendinosis:
[ ]2: Br J Sports Med. 2007 Apr;41(4):217-23. Epub 2007 Jan 29. LinkOut
The evolution of eccentric training as treatment for patellar tendinopathy (jumper's knee): a critical review of exercise programmes.
Visnes H, Bahr R.
Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
BACKGROUND AND AIM: Eccentric training has become a popular treatment for patellar tendinopathy. Our purpose was to review the evolution of eccentric strength training programmes for patellar tendinopathy with a focus on the exercise prescriptions used, to help clinicians make appropriate choices and identify areas needing further research. METHODS: A computerised search of the entire MEDLINE database was performed on 1 September 2006 to identify prospective and randomised clinical trials with a focus on clinical outcome of eccentric training for patellar tendinopathy. RESULTS: 7 articles with a total of 162 patients and in which eccentric training was one of the interventions, all published after 2000, were included. The results were positive, but study quality was variable, with small numbers or short follow-up periods. The content of the different training programmes varied, but most were home-based programmes with twice daily training for 12 weeks. A number of potentially significant differences were identified in the eccentric programmes used: drop squats or slow eccentric movement, squatting on a decline board or level ground, exercising into tendon pain or short of pain, loading the eccentric phase only or both phases, and progressing with speed then loading or simply loading. CONCLUSION: Most studies suggest that eccentric training may have a positive effect, but our ability to recommend a specific protocol is limited. The studies available indicate that the treatment programme should include a decline board and should be performed with some level of discomfort, and that athletes should be removed from sports activity. However, these aspects need further study.
[ ]3: Phys Ther. 2006 Mar;86(3):450-6. LinkOut
Is there evidence to support the use of eccentric strengthening exercises to decrease pain and increase function in patients with patellar tendinopathy?
Rabin A.
Accelerated Rehabilitation Center, Farmington Hills, Michigan, USA.
[ ]4: Sports Med. 2005;35(1):71-87.LinkOut
Patellar tendinopathy in athletes: current diagnostic and therapeutic recommendations.
Peers KH, Lysens RJ.
Department of Physical Medicine and Rehabilitation, Gasthuisberg and Pellenberg University Hospitals, Leuven, Belgium. Koen.Peers@uz.kuleuven.ac.be
Formerly known as 'jumper's knee', patellar tendinopathy gives rise to considerable functional deficit and disability in recreational as well as professional athletes. It can interfere with their performance, often perseveres throughout the sporting career and may be the primary cause to end it. The diagnosis of patellar tendinopathy is primarily a clinical one but new imaging techniques, such as Doppler ultrasonography, may provide additional diagnostic value. Current therapeutic protocols are characterised by wide variability ensuing from anecdotal experience rather than evidence. Moreover, numerous reports in recent years have shattered previous doctrines and dogmatic belief on tendon overuse. Histopathological and biochemical evidence has indicated that the underlying pathology of tendinopathy is not an inflammatory tendinitis but a degenerative tendinosis. Consequently, pain in chronic patellar tendinopathy is not inflammatory in nature, but its exact origin remains unexplained. In pursuit of pathology- and evidence-based management, conservative therapy should be shifted from anti-inflammatory strategies towards a complete rehabilitation with eccentric tendon strengthening as a key element. If conservative management fails, surgery is opted for. However, considering the heterogeneity of surgical procedures and the absence of randomised studies, no conclusive evidence can be drawn from the literature regarding the effectiveness of surgical treatment for patellar tendinopathy. Parallel with the improved knowledge on the pathophysiology and pain mechanisms in patellar tendinopathy, new treatment strategies are expected to emerge in the near future.
[ ]5: Br J Sports Med. 2004 Dec;38(6):758-61.  Cited Articles, Free in PMC, Cited in PMC, LinkOut
Patellar tendinosis as an adaptive process: a new hypothesis.
Hamilton B, Purdam C.
Australian Institute of Sport, Leverrier Crescent, Bruce, ACT, Australia. bruce.hamilton@eis2win.co.uk
BACKGROUND: Patellar tendinosis (PT), or "jumper's knee" is a common condition in athletes participating in jumping sports, and is characterised by proximal patellar tendon pain and focal tenderness to palpation. Hypoechoic lesions observed in the proximal patellar tendon associated with the tendinosis are typically described as being a result of degenerative change or "failed healing". We propose a new model for the development of the hypoechoic lesion observed in PT, in which the aetiology is an adaptive response to differential forces within the tendon. METHODS: We assessed the clinical, histopathological, and biomechanical literature surrounding the patellar tendon and integrated this with research into the response of tendons to differential forces. RESULTS AND CONCLUSIONS: We propose that the hypoechoic lesion commonly described in PT is the result of adaptation or partial adaptation of the proximal patellar tendon to a compressive load. We postulate that the biomechanics of the patellar-patellar tendon interface creates this compressive environment. Secondary failure of the surrounding tensile adapted tendon tissue may result in tissue overload and failure, with resultant stimulation of nociceptors. We believe that this "adaptive model" of patellar tendinosis is consistent with the clinical and histological findings
[ ]6: Sports Med. 1999 Jun;27(6):393-408.Substance (MeSH Keyword), Cited in PMC, LinkOut
Histopathology of common tendinopathies. Update and implications for clinical management.
Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M.
School of Human Kinetics, University of British Columbia, Vancouver, Canada. kkhan@interchange.ubc.ca
Tendon disorders are a major problem for participants in competitive and recreational sports. To try to determine whether the histopathology underlying these conditions explains why they often prove recalcitrant to treatment, we reviewed studies of the histopathology of sports-related, symptomatic Achilles, patellar, extensor carpi radialis brevis and rotator cuff tendons. The literature indicates that healthy tendons appear glistening white to the naked eye and microscopy reveals a hierarchical arrangement of tightly packed, parallel bundles of collagen fibres that have a characteristic reflectivity under polarised light. Stainable ground substance (extracellular matrix) is absent and vasculature is inconspicuous. Tenocytes are generally inconspicuous and fibroblasts and myofibroblasts absent. In stark contrast, symptomatic tendons in athletes appear grey and amorphous to the naked eye and microscopy reveals discontinuous and disorganised collagen fibres that lack reflectivity under polarised light. This is associated with an increase in the amount of mucoid ground substance, which is confirmed with Alcian blue stain. At sites of maximal mucoid change, tenocytes, when present, are plump and chondroid in appearance (exaggerated fibrocartilaginous metaplasia). These changes are accompanied by the increasingly conspicuous presence of cells within the tendon tissue, most of which have a fibroblastic or myofibroblastic appearance (smooth muscle actin is demonstrated using an avidin biotin technique). Maximal cellular proliferation is accompanied by prominent capillary proliferation and a tendency for discontinuity of collagen fibres in this area. Often, there is an abrupt discontinuity of both vascular and myofibroblastic proliferation immediately adjacent to the area of greatest abnormality. The most significant feature is the absence of inflammatory cells. These observations confirm that the histopathological findings in athletes with overuse tendinopathies are consistent with those in tendinosis--a degenerative condition of unknown aetiology. This may have implications for the prognosis and timing of a return to sport after experiencing tendon symptoms. As the common overuse tendon conditions are rarely, if ever, caused by 'tendinitis', we suggest the term 'tendinopathy' be used to describe the common overuse tendon conditions. We conclude that effective treatment of athletes with tendinopathies must target the most common underlying histopathology, tendinosis, a noninflammatory condition.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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RE: Pattelar tendenitis - April 28, 2008 11:40:52 PM
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fapt
Posts: 57
Joined: October 22, 2004
From: Taiwan, R.O.C.
Status: offline
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To Jason L. Harris, PT, DPT :
Thans your interesting abstracts and free links. I think that is so helpful and give me new knowledge to me.
_____________________________
夏之日，冬之夜，百歲之後，歸于其居。
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RE: Pattelar tendenitis - April 29, 2008 8:53:39 AM
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orthotherapist
Posts: 201
Joined: February 6, 2007
Status: offline
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Try this link to see if someone with expertise in dance injuries works in your area
http://www.orthopt.org/sig_pa.php
It is through the orthopedic section of our professional organization.
Hope this helps
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