The effect of therapeutic modalities on tendinopathy

Abstract

Degenerative tendon problems often prove recalcitrant to many forms of non-operative care [1]. Frequently, optimal functional outcomes and patient goals are not attained due to the persistence of chronic pain, loss of motion, and weakness. Ideally, rehabilitative goals should rely upon evidence-based clinical practice applied at appropriate intervals to facilitate healing and repair of injured tendons. In practice, understanding when and how to use therapeutic modalities to aid in healing and the recovery of function can often be unclear. For the therapist, modalities serve as an adjunct to directed exercise and have historically been utilized in the treatment of soft tissue injuries to decrease pain, inflammation, and edema, or to increase tissue extensibility [2]. In the era of evidence-based practice, the challenge is to relate the use of therapeutic modalities to demonstrate a healing response or the advancement of a specific functional goal. Recent histopathological studies of degenerated tendons have demonstrated varying underlying pathologies; the role of inflammation in intratenonous injury may be overstated [3].The diagnosis of tendonitis often overshadows the histopathological evidence of degenerative tendinosis [3-5].However, paratenonitis clearly has an inflammatory pathobiology. Therefore, the clinician must have an understanding of the mechanism of tendon injury and underlying pathology in order to deliver the most appropriate care. At question is whether the current accepted practice of employing modalities in tendon injury treatment is valid given the cellular pathology associated with tendinopathy and can their use be matched with a quantitative functional outcome measure. This chapter will examine the best available evidence on biological and functional efficacy of therapeutic modalities.