Rehabilitation after tendon injuries

Abstract

Chronic tendinopathy remains a clinical dilemma. The best treatment is not always possible or recognized, or the patient may be unable to follow the ideal treatment strategy because of recreational or work-related demands. An ideal treatment will resolve the current symptoms and prevent their return, and should be based on good science, common sense, and clinical results. The use of exercise to treat chronic tendinopathy began with a knowledge of tendon loading during activity, the science of tendon adaptation to increased stress, and the common sense of patient participation based on ability to perform. There now is a growing body of evidence suggesting that eccentric exercise is successful in treating chronic tendinopathy, but most of these studies suffer from many of the same limitations of other clinical studies-small numbers, lack of randomization, lack of a control group, lack of a uniform diagnostic system, lack of agreement on outcome assessment, and so on. The literature suggests that chronic tendinopathy may persist if untreated [93,169,187], but the natural history of chronic tendinopathy is still not clear [93,175]. Exercise alone will not solve all cases of tendinopathy. Clinical judgment is essential, and a careful analysis and systematic elimination of many other factors is often involved. Once these influences have been removed, knowledge of the adaptation of tendon in response to tensile loading can be used to successfully manage most tendon injuries.F.