Every Monday you will find a high-quality research study that has been summarized for you here on Physiospot. The articles are chosen because they are of high quality, impact and likely to shape your clinical practice. After all, it is difficult to find the gemstones in all of the research published daily. So let's do the hard work for you.
Tendonopathy most frequently affects the wrist flexors, wrist extensors, the rotator cuff, the patella and the Achilles tendons. It is characterized by a clinical syndrome of pain, swelling, and loss of function and is thought to be caused by an abnormal healing response within the tendon itself, although this is often discussed. The term tendinopathy is a general descriptor of the clinical conditions (both pain and pathological features) associated with overuse in and around tendons.
Conservative treatment is the mainstay of tendinopathy treatment, with ultrasound, laser therapy, shock wave and exercise being the main treatments of choice. The best treatment protocol for each of these treatment options is poorly defined, and there are many conflicting studies, many of which are modality-specific rather than disease-oriented. This adds further confusion as, although histological studies confirm a similar pathological process, as there are differences in each tendon.
The aim of this systematic revival was to summarize the evidence of the effectiveness of physiotherapy interventions for the treatment of tendinopathy as a single disease unit in the last decade, as determined in systematic reviews (SRs) and / or meta-analyzes (MAs).
40 SR & MA were included in the qualitative synthesis – only 5 MA were included in the quantitative synthesis. The articles included in the review were published in pubmed, PEDro and Scopus between 2010 and 2020. GRADE principles and the AMstar 2 tool were used to ensure methodological quality. Studies were only included when their aim was
to determine the effectiveness of physical therapy interventions in the treatment of tendinopathy (without limitation to a specific anatomical location). Outcome measures included pain (VAS or NPRS) and functions that are specific to each affected joint.
Results
Eccentric training showed positive effects in reducing pain and improving function. Suitable for long-term management and functional improvement. This is consistent with the existing literature.
Isometric exercises are effective for short-term pain reduction
Eccentric training is likely to be effective due to neuromuscular adaptations, collagen synthesis, and pain habituation. The optimal protocol is unknown.
Shockwave can be a useful method of treatment to relieve pain and improve function. However, there are not enough high quality studies to draw firm conclusions.
There is not enough evidence to draw firm conclusions about laser therapy.
Ultrasound was no more effective than placebo.
Clinical implications
It seems that eccentric movement is still the treatment for tendinopathies. Shockwave may provide an alternative option for pain reduction and allow the pain to be reduced to a point where you can begin exercising. Oh, and we can all put the ultrasound machine away now.
Would you like to learn more about tendons from an expert?
EBP in tendinopathy
In evidence-based practice, the aim is to combine the best evidence research with clinical expertise and patient preference. Applying an evidence-based, practice-based approach to treating tendinopathy is not as straightforward as applying a series of research from a single article in a prescription format to a patient. Each patient presents a unique clinical picture. The therapist managing the patient should use a broad evidence base to clinically justify a comprehensive management plan. It is important that management is not prescription driven but based on the best evidence available at the time, taking into account that evidence based practice is fluid and constantly changing as more evidence is produced.
Review the Latest Evidence
