068. Lower limb tendinopathy loading, running and rehab with Dr Peter Malliaras

There are a range of tendinopathy presentations, from easily diagnosed with a local area of pain and clear pain response to tissue overload; through to patients with trickier presentations and multiple contributors to pain e.g. long term proximal hamstring or gluteal tendinopathy with a lumbar spine radiculopathy.

How can you diagnose and treat patients with complex tendinopathy presentations? How does the latest research around tendinopathy help us? I explore these issues and more with Dr Peter Malliaras in episode 68 of the Physio Edge podcast. We also explore:

• Do tendinopathy patients always present with a small area of pain, or can they have pain in larger, more diffuse areas?
• How will you identify tendinopathy or other structures that may be contributing to your patients symptoms?
• Clues in your patients' history to help you identify and differentiate tendinopathies, lumbar and SIJ referral
• Symptoms and how your treatment will differ in patients with paratenon and fat pad involvement
• How can you measure your patients load tolerance?
• What categories of tendinopathy patients can you use to help differentiate your treatment?
• How can you rehabilitate patients with tendinopathy?
• What role does biomechanics have?
• What advice can you provide to your patients about load management, symptoms and flareups?
• When is it ok for your patients to continue or return to running?
• What strength tests should your patients be able to complete before returning to running?
• If your patients are not tolerating running, which aspects should you modify first - frequency, intensity, type or duration?
• When are isometrics useful in your treatment?
• When can you start isotonic and plyometric exercises?
• How can you incorporate tendon neuroplastic training (TNT)?

Links associated with this episode

• Download your podcast handout
• Dr Peter Malliaras on Twitter
• Tendinopathy rehab blog with Dr Peter Malliaras
• Get your free trial Clinical Edge membership
• David Pope on Twitter
• Clinical Edge on Facebook

Other episodes of interest:

• PE 046 - Proximal hamstring tendinopathy with Tom Goom
• PE 042 – Treatment of plantaris and Achilles tendinopaty with Seth O’Neil
• PE 023 – Lower limb tendinopathies with Dr Pete Malliaras

Articles associated with this episode:

• Coombes et at. 2016. Isometric exercise above but not below an individuals pain threshold influences pain perception in people with lateral epicondylalgia

• Rio et al. 2015. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy

• Silbernagel et al. 2007a. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled trial.

• Silbernagel et al. 2007. Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy.