Ultrasound for tendonitis

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Hi all. I was hoping for some exoerience based views on the use of ultrasound therapy for treating tendinitis (excluding plantar fasciitis). The argument that it is placebo based interests me greatly but I am more concerned about whether anyone has found it to have good results, regardless of how??

James.

 

I don't use ultrasound for treatment, but often refer to physio's who may use ultrasound for certain conditions.

You may want to differenciate between tendonitis (a more acutely presenting tendon pain) involving the paratendon, and tendinosis (a primary degenerate problem) which is usually in your middle aged person.

It depends on what area you are treating but are you familiar with an eccentric strengthening programme for tendinopathy?

 

James

I am a 92kg and 48yrs old (and almost middle aged) and I've had Bilateral tendonosis/peritendonitis (I think) for about 6months, Post static pain is worse, I hobble in the mornings, the ach tendon is painul to palpate, cant sprint, can run cross country but not on hard surfaces and although I train many times a week (mostly Judo karate and MMA) I have to avoid high repetitive high impact activities like skipping or shuttle runs etc. It doesn't matter what treatment I have, which includes orthoses, heel lifts, physio, ultrasound, RICE, stretching of various types, rest, Dichlophenac NSAID, it continues to be a problem. Steroid injections are contraindicated in Ach tendon so I think the only way to resolve this will be surgical decompression which I'm avoiding for now as a lay off from training means having to go thru that barrier of starting again which can be very difficult as you get older. I think this is a similar synopsis for most tendonosis problems in the partially young. (Ok old B'stards in a mid life crisis trying to regain their youth thru sporting prowess. Which I did prove the other day at Judo when a bunch of 20 something 2nd Dan Japaneses heavyweights (well one of them was around 115KG (250lb)) came to the club and I thrashed them all over the mat, Brilliant.) Cheers Dave Smith
PS does ankle maipulation to improve Dflex RoM improve this condition, I am a little equinus in the ankle.

 

Dave Smith,

Are you familiar with the eccentric strengthening programme put forward by Alfredson back in 1997?

90 single leg drop-down's off a step per day is the gold standard conservatively. Usually start with double leg with 3x15 in the morning and the same in the afternoon. The progress towards the single leg drop down as soon as you can.

Post back here if you would like any more information. A surgical option should not be looked at until you have attempted at least 6 months of this alongside all you other treatments.

Gareth

 

Gareth

No haven't tried that and not heard of Alfredson. Sounds simple enough is there any more to know about that technique?

Cheers Dave

 

Dave,

Have you heard of a technique involving the injection of sterile water or saline + local anaesthetic into the Achilles tendon/paratendon area?

This was only described to me last week by a physio colleague who works in Premiership football. The theory is that the physical pressure of the injection ruptures the adhesions between the paratendon/tendon (those which would normally be ruptured/scraped away during a decompression.

Elements of pro-soccer are excited since the results would seem to be the same or similar to a full-blown decompression, but without the surgery or long rehab.

I know there is someone (an orthopod I think) using this technique in the UK, but have no more data on it.

Hope this is of interest.

Cheers,
davidh

 

The Clinical Sports Medicine textbook website has some recent info regarding management of tendinopathies:

http://www.clinicalsportsmedicine.com/presentations.htm

Cheers,

Hylton

 

Gareth

After researching Alfredson I found this paper
"The chronic painful Achilles and patellar tendon: research on basic biology and treatment.Alfredson H."
Which showed that there is often only normal levels of Prostaglandin PGE2 in painful achilles tendinopathies. Do you, or any one else, know if this means that painful tedinopathies do not necessarily show signs of immflamation, such as might be seen (or not seen) on a sonogram. Also are all soft tissue pathologies echogenic to ultrasound scan.

David H

Haven't come across that therapy before I will have to look into it.
I have read about injections of a sclerosing agent called Polidocanol in the above paper.

Cheers Dave Smith