In the new healthcare model, results rule! But what exactly constitutes results? The ubiquitous symptom of pain can be quite dynamic and often responds quickly to conservative treatment- and short-term goals of pain relief certainly yield positive outcome measures.
Conversely, structural tendon changes occur slowly, perhaps over years. Ryan and his colleagues argue that although structural pathologies like supraspinatus tendinopathy or lateral eipcondylopathy may exist without symptoms; these problems may increase the risk of future pain. (1) Clinicians must address tendinopathies by employing tendon-remodeling strategies to improve long-term results.
Rehabilitation of tendinopathies has been a hot topic over the past several years. Long-term rehab depends on adequately “tensioning” the muscle-tendon over time. Tension remodels the tendon and builds structural capacity to prevent future injury. Most research points to eccentric strengthening as the best option. A study by Couppe highlights potential mechanisms that explain how isolated eccentrics are beneficial, but in practicality, performing eccentric-concentric movements seems to be as effective, or in some cases even more effective. (2)
Finally, no care plan would be complete without addressing the “functional” problems that triggered the problem in the first place. Without changing your patient’s upper crossed syndrome and improper workstation mouse height, your treatment plan for their rotator cuff problem has little hope. (See this prior Tendinopathy blog for details).
So to answer the “symptoms, structure or function” question; “results” must include all 3 components. Effective care plans must quickly alleviate symptoms, while remodeling structural “weak links” and removing functional threats. Once you’ve made the correct diagnosis, ChiroUp helps with the rest.
1. Ryan M, Bisset L, Newsham-West R. Should We Care About Tendon Structure? The Disconnect Between Structure and Symptoms in Tendinopathy. Journal of Orthopaedic & Sports Physical Therapy, 2015 (45):11; 823–825.
2. Svensson R, et al. Eccentric or Concentric Exercises for the Treatment of Tendinopathies? J Orthop Sports Phys Ther 2015;45(11):853-863. Epub 15 Oct 2015.
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