Tendonopathies continue to be the bane of health professionals treating those associated with repetitive loading work or sport. We still do not know where the pain comes from; we do have some support for the use of eccentric strengthening regimes in their treatment. These treatments do take time and results are usually associated with partial outcomes rather than complete. The injuries are usually in tendons associated with the two joint muscles such as carpi radialis brevis (tennis elbow), and the patella tendon (rectus femoris).
Classically there is a loss of normal collagen organisation, with deteriorated mechanical properties, particularly elasticity and maximum stress failure.
A recent article in the BJSM has suggested that increased load duration results in tendon protein kinases, causing apoptosis (programmed cell death). Increased cell death results in poor collagen synthesis and matrix remodelling more prone to tearing and injury.
Treatment manages the rest/load ration allowing enough stress for remodelling and growth but not enough to cause apoptosis.
In another article in the BJSM authors have suggested that tendon healing, even when successful, does not result in normal tendon. Mostly, the result is functionally satisfactory; although the recurrence rate suggests long term this may not be so. The therapeutic use of growth factors by gene transfer seem promising in the quest for to produce new healthy and normal tendon tissue after conservative treatment has failed.
(Ref. Murrell G. BJSM. 2003; 36;392-393, Maffulli. BJSM. 2003 36:315-316)
Questions/Comments >>
