Talk prepared for Circle Bedfordshire MSK GP Education Event on Wednesday 22nd Match 2017

1. Tendinopathy
Dr. Richard Collins
Sport & Musculoskeletal Physician
Bedfordshire MSK

2. Talk overview
1. Tendinopathy cause
2. Core principles of evidence based treatment
3. Place of adjunct treatment

3. 1. Tendinopathy cause
Musculotendinous Overload

5. Main functions
• Joint movement
• Primary movers
• Joint stabilisation
• Platform on which the primary movers can work
• Energy absorption, storage & release
• Long, lower limb tendons
• Part of propulsion mechanics

6. Achilles & Patellar Tendon

7. Functional Overload

8. Functional Overload
Structural degradation

13. Warning!
Structural changes are often a normal part of
ageing
Not necessarily associated with symptoms
Interpret imaging carefully

14. Symptoms
• Pain (especially on activating normal function)
• Swelling
Loss of function

15. 2. Treatment Principles?
Restore Capacity!

16. What will do this?
• Accupuncture?
• Massage?
• Supporting mechanics?
• Muscle strengthening?
‘Physio’
As insightful as the word ‘Drugs’

17. •Supporting mechanics
•Muscle strengthening
Physio ✅

18. How long does it take?
•At least 12 weeks (c.f stress fracture)
•Are you doing them?! (taking their drugs)
•Are you doing them in a graded, increased way?

19. Approaches
•Lower Limb Long Tendons?
•Rotator Cuff?
•Tennis Elbow?

20. 3. Adjuncts
Only if struggling with rehab
= Pain

21. Options?
• Oral/Topical Analgesia?
• Safe to tendons
• Side-effects?
• Steroid Injections?
• Analgesics
• Weaken tendon collagen
• Autologous Blood/Platelet Rich Plasma?
• Safe to tendons
• What are they adding?
• Shockwave Therapy
• Analgesic
• Safe to tendons in skilled hands

22. Talk take home
1. Tendinopathy cause
Functional Overload
2. Core principles of evidence based treatment
Restore capacity through supporting function and strengthening
muscle
3. Place of adjunct treatment
Shockwave Therapy represents the best evidenced and safest
approach – but only if appropriate rehab is failing

23. Questions?