REHABILITATION TENDON INJURIES

very useful to offload the tendon as necessary. Surgery

Surgery is often advocated but is usually not necessary if adequate conservative measures have been pursued. Surgery should therefore be reserved for the following specific circumstances: n Where there is bony impingement upon the tendon. An example is in Haglund’s syndrome, which is a combination of insertional Achilles tendinopathy, retrocalcaneal bursitis and a posterosuperior calcaneal process that impinges upon the tendon, in which case resection of the bony prominence can provide good results. Another example is the subacromial osteophyte causing mechanical impingement upon the supraspinatus tendon. n Acute partial tendon tear, eg. of the supraspinatus after a fall. n Acute rupture, eg. of the Achilles tendon.

SUMMARY Tendon injuries are common in athletes and can have significant consequences.

Different components of the tendon can be affected, and this influences management. The optimal strategy for managing these complaints is accurate diagnosis and classification of the injury, identification and correction of underlying causes, and promotion of healing, particularly through thorough rehabilitation, including eccentric work. Pain management should be ensured through modalities, topical treatments and medication. Injection therapies may be useful, but only in a minority of cases.

References 1. Robinson JM, Cook JL, Purdam C, et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. British Journal of Sports Medicine 2001;35:335–341 2. Visentini PJ, Khan KM, Cook JL, et al. The VISA score: an index of severity of symptoms in patients with jumper’s knee (patellar tendinosis). Journal of Science and Medicine in Sport 1998;1:22–28 3 Jonsson P, Alfredson H, Sunding K, et al. New regimen for eccentric calf muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot- study. British Journal of Sports Medicine 2008;42:746–749

4. Purdam CR, Jonsson P, Alfredson H, et al. A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy. British Journal of Sports Medicine 2004;38:395–397 5. Speed CA. Therapeutic ultrasound in soft tissue lesions. Rheumatology (Oxford) 2001;40:1331–1336 6. Alfredson H, Ohberg L. Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial. Knee Surgery, Sports Traumatology,

Arthroscopy 2005;13:338–344.

THE AUTHORS Dr Cathy

TH

Dr Cathy Speed is a consultant in rheumatology and sport and exercise medicine at Addenbrooke’s and Cambridge Lea

Cambridge Lea Hospitals, Cambridge and

Hospital of St John and St Elizabeth, London. She is lead physician to the English Institute of Sports, Eastern Region as well as physician to Badminton England, Middlesex County Cricket Club at the Lords Ground, London and also to the English Ladies Golf Association. Dr Speed is also a fellow of the faculty of sport and exercise medicine and authored both Soft Tissue Rheumatology (ISBN 0-19-263093-8) and Soft Tissue Disorders (ISBN 1903734576).

www.sportEX.net

11