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Prevention and Treatment of Overuse Tendon Injuries

Summary

Overuse injuries are common in recreational and competitive sports as well as in day-to-day activities. The musculotendinous unit comprises the tissue most frequently involved: structural damage to the tendon occurs from repetitive strain and loading, from either endurance or skill activities that require technique and power. The potential for injury is enhanced by a great variety of predisposing intrinsic or extrinsic factors. Tendinous tissue will become fatigued as its basal reparative ability is overwhelmed by repetitive dysfunctional and microtraumatic processes. Tendinitis is the earliest recognisable manifestation of overuse injury: as damage progresses, partial tears and complete ruptures may ensue.

The diagnosis of overuse injury rests with identification not only of the affected tendinous unit, but also of the underlying predisposing condition or conditions. Treatment can then proceed with elimination or correction, if possible, of these conditions, together with control of inflammation and programmes of modalities designed to restore the structural and functional integrity of the tendon.

Knowledge of overuse problems has grown exponentially in the past 3 decades, as evidenced by the outpouring of scientific and medical literature. Sophisticated analytical techniques, supplementing a sound history and physical examination, have greatly facilitated the diagnosis of overuse problems and allowed the application of scientific therapeutic principles. As the number of participants in recreational activities continues to grow, the application of these techniques in ever more innovative ways holds the greatest promise for the prevention of overuse tendon injuries.

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References

  1. Anderson B. Stretching, Shelter Publications, Inc., Bolinas, 1980

    Google Scholar 

  2. Banga AK, Chien YW. Iontophoretic delivery of drugs: fundamentals, developments and biomedical applications. Journal of Controlled Release 7: 1–24, 1988

    Article  CAS  Google Scholar 

  3. Barfred T. Experimental rupture of the Achilles tendon: comparison of various types of experimental rupture in rats. Acta Orthopaedica Scandinavica 42: 528–543, 1971

    PubMed  Article  CAS  Google Scholar 

  4. Beltran J, Noto A, Herman L, Lubbers L. Tendons: high-field-strength, surface coil MR imaging. Radiology 162(3): 735–740, 1987

    PubMed  CAS  Google Scholar 

  5. Bodne D, Quinn S, Murray W, Bolton T, Rudd S. Magnetic resonance images of chronic patellar tendinitis. Skeletal Radiology 17: 24–28, 1988

    PubMed  Article  CAS  Google Scholar 

  6. Ciullo JV, Zarins B. Biomechanics of the musculotendinous unit: relation to athletic performance and injury. Clinics in Sports Medicine 2: 71–86, 1983

    PubMed  CAS  Google Scholar 

  7. Clancy WG. Tendinitis and plantar fasciitis in runners. Cited in D’Ambrosia & Drez. Prevention and treatment of running injuries, Slack, Inc., Thorofare, 1982

    Google Scholar 

  8. Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendonitis: etiology and treatment. American Journal of Sports Medicine 12(3): 179–184, 1984

    PubMed  Article  CAS  Google Scholar 

  9. Clement DB, Taunton JE, Smart GW, McNicol KL. A survey of overuse running injuries. Physician and Sportsmedicine 9(5): 47–58, 1981

    Google Scholar 

  10. Curwin S, Stanish W. Tendinitis: its etiology and treatment, Collamore Press, Lexington, 1984

    Google Scholar 

  11. D’Ambrosia RD. Orthotic devices in running injuries. Clinics in Sports Medicine 4: 611–618, 1985

    PubMed  Google Scholar 

  12. DeVries HA. Quantitative electromyografic investigation of the spasm theory of muscle pain. American Journal of Physical Medicine 45: 119–134, 1966

    CAS  Google Scholar 

  13. Dirix A, Knuttgen HG, Tittel K (Eds). The Olympic book of sports medicine, Vol. 1, Blackwell Scientific Publications, Oxford, 1988

    Google Scholar 

  14. Duda M. Prevention and treatment of throwing-arm injuries. Physician and Sports medicine 13(6): 181–220, 1985

    Google Scholar 

  15. Duda M. New artificial turf may reduce injuries. Physician and Sportsmedicine 14(9): 38, 1986

    Google Scholar 

  16. Ehman R, Berquist T. Magnetic resonance imaging of musculo-skeletal trauma. Radiologic Clinics of North America 24(2): 291–319, 1986

    PubMed  CAS  Google Scholar 

  17. Elliott DH. Structure and function of mammalian tendon. Biological Reviews 40: 392–421, 1965

    PubMed  Article  CAS  Google Scholar 

  18. Fornage B, Rifkin M, Touche D, Segal P. Sonography of the patellar tendon. American Journal of Roentgenology 143: 179–182, 1984

    PubMed  CAS  Google Scholar 

  19. Fornage B, Schernberg F, Rifkin M. Ultrasound examination of the hand. Radiology 155: 785–788, 1985

    PubMed  CAS  Google Scholar 

  20. Friden J, Seger J, Sjostrom M, Ekblom B. Adaptive response in human skeletal muscle subjected to prolonged eccentric training. International Journal of Sports Medicine 4: 177–183, 1983

    PubMed  Article  CAS  Google Scholar 

  21. Friden J, Sjostrom M, Ekblom B. Myofibrillar damage following intense eccentric exercise in man. International Journal of Sports Medicine 4: 170–176, 1983

    PubMed  Article  CAS  Google Scholar 

  22. Fritschy D, de Gautard R. Jumper’s knee and ultrasonography. American Journal of Sports Medicine 16(6): 637–640, 1988

    PubMed  Article  CAS  Google Scholar 

  23. Glass JM, Stephen RL, Jacobson SC. The quantity and distribution of radiolabeled dexamethasone delivered to tissue by iontophoresis. Pharmacology and Therapeutics 19: 519–525, 1980

    CAS  Google Scholar 

  24. Griffin JE, Karselis TC. Physical agents for physical therapists, Charles C. Thomas, Springfield, 1978

    Google Scholar 

  25. Herring S, Nilson K. Introduction to overuse injuries. Clinics in Sports Medicine 6(2): 225–239, 1987

    PubMed  CAS  Google Scholar 

  26. Hunter S, Poole R. The chronically inflamed tendon. Clinics in Sports Medicine 6(2): 371–388, 1987

    PubMed  CAS  Google Scholar 

  27. James S, Bates B, Osternig L. Injuries to runners. American Journal of Sports Medicine 6(2): 40–50, 1978

    PubMed  Article  CAS  Google Scholar 

  28. Jobe F, Moynes D, Tibone J, Perry J. An EMG analysis of the shoulder in pitching: a second report. American Journal of Sports Medicine 12(3): 218–220, 1984

    PubMed  Article  CAS  Google Scholar 

  29. Jobe F, Tibone J, Perry J, Moynes D. An EMG analysis of the shoulder in throwing and pitching: a preliminary report. American Journal of Sports Medicine 11(1): 3–5, 1983

    PubMed  Article  CAS  Google Scholar 

  30. Kozar B, Lord RM. Overuse injury in the young athlete: reasons for concern. Physician and Sportsmedicine 11(7): 116–122, 1983

    Google Scholar 

  31. Kvist M, Jarvinen M. Clinical, histochemical and biomechanical features in repair of muscle and tendon injuries. International Journal of Sports Medicine 3: 12–14, 1982

    PubMed  Article  Google Scholar 

  32. Mack L, Matsen F, Kilcoyne R, Davies P, Sickler M. US evaluation of the rotator cuff. Radiology 157: 205–209, 1985

    PubMed  CAS  Google Scholar 

  33. Noble CA. Iliotibial band friction syndrome in runners. American Journal of Sports Medicine 8(4): 232–234, 1980

    PubMed  Article  CAS  Google Scholar 

  34. Noyes FR, Torvik PJ, Hyde WB, et al. Biomechanics of ligament failure: an analysis of immobilization, exercise, and reconditioning effects in primates. Journal of Bone and Joint Surgery 56: 1406, 1974

    PubMed  CAS  Google Scholar 

  35. Pappas AM, Zawacki RM, Sullivan TJ. Biomechanics of baseball pitching: a preliminary report. American Journal of Sports Medicine 13(4): 216–222, 1985

    PubMed  Article  CAS  Google Scholar 

  36. Perugia L, Postacchini F, Ippolito E. The tendons-biology-pathology-clinical aspects, Kurtis, Milano, 1986

    Google Scholar 

  37. Quillin WS. Ultrasound phonophoresis. Physician and Sportsmedicine 10: 211, 1982

    Google Scholar 

  38. Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. Journal of Bone and Joint Surgery 52-B: 540–553, 1970

    Google Scholar 

  39. Renstrom P, Johnson R. Overuse injuries in sports: a review. Sports Medicine 2: 316–333, 1985

    PubMed  Article  CAS  Google Scholar 

  40. Renstrom P, Peterson L. Groin injuries in athletes. British Journal of Sports Medicine 14: 30–36, 1980

    PubMed  Article  CAS  Google Scholar 

  41. Smart GW, Taunton JE, Clement DB. Achilles tendon disorders in runners: a review. Medicine and Science in Sports and Exercise 12(4): 231–243, 1980

    PubMed  Article  CAS  Google Scholar 

  42. Stanish W. Overuse injuries in athletes: a perspective. Medicine and Science in Sports and Exercise 16(1): 1–7, 1984

    PubMed  Article  CAS  Google Scholar 

  43. Stanish W, Curwin S, Rubinovich M. Tendinitis: the analysis and treatment for running. Clinics in Sports Medicine 4(4): 593–609, 1985

    PubMed  CAS  Google Scholar 

  44. Subotnick S. Orthotic foot control and the overuse syndrome. Archives of Podiatric Medicine and Foot Surgery 2(3): 207–213, 1975

    Google Scholar 

  45. Subotnick S. Foot orthoses: an update. Physician and Sportsmedicine 2(11): 103–109, 1983

    Google Scholar 

  46. Tullos HS, King JW. Throwing mechanism in sports. Orthopaedic Clinics of North America 4: 709–720, 1973

    CAS  Google Scholar 

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Correspondence to Stephen C. Hunter.

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Hess, G.P., Cappiello, W.L., Poole, R.M. et al. Prevention and Treatment of Overuse Tendon Injuries. Sports Med 8, 371–384 (1989). https://doi.org/10.2165/00007256-198908060-00005

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Keywords

  • Rotator Cuff
  • Achilles Tendon
  • Tendinitis
  • Overuse Injury
  • Tendon Injury