Ep 365: Professor Peter Malliaras ‘Tendinopathy Rehabilitation’
Feb 24, 2025
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Professor Peter Malliaras, a leading tendinopathy expert and director at Monash University’s Musculoskeletal Research Unit, shares invaluable insights into tendon rehabilitation. He discusses cutting-edge treatment strategies and highlights the importance of personalized loading techniques. The conversation delves into how biopsychosocial factors affect outcomes, the role of muscle activation, and the nuances of pain management. With a focus on recent research and evolving strategies, this is a must-listen for athletes and practitioners alike on the path to recovery.
Recent advancements emphasize tailored exercise prescriptions for tendon rehabilitation, focusing on goals like tissue adaptation and pain management.
A biopsychosocial model is essential in understanding tendon pain, recognizing that psychosocial factors can significantly influence symptoms beyond mechanical issues.
Deep dives
Advancements in Tendon Rehabilitation Practices
Recent advancements in the field of tendon rehabilitation emphasize clarity in exercise prescription tailored to individual patient outcomes. Practitioners now understand the importance of differentiating between various goals, such as tissue adaptation, muscle adaptation, and pain management. While exercise has long been a part of tendon treatment, the application has evolved to focus not just on alleviating pain but also on enhancing functional performance. This shift has allowed clinicians to optimize loading strategies based on specific tendon types, like the patellar or Achilles tendon, for better rehabilitation outcomes.
Biopsychosocial Factors in Tendon Pain
The understanding of tendon pain now incorporates a biopsychosocial model, acknowledging that pain is influenced by various factors beyond mechanical loading. Practitioners are encouraged to recognize that tendon pathologies can exist without changes in physical activity or loading, indicating other psychosocial factors may play a significant role. For instance, life stressors or medication changes can impact an individual's experience of pain, often complicating the correlation between tendon pathology and symptoms. This comprehensive perspective prompts practitioners to screen for a range of factors and customize their treatment approaches accordingly.
Isometric Loading for Optimal Tendon Adaptation
Recent insights suggest that short-duration isometric contractions can effectively promote tendon stiffness and adaptation more than longer holds. This approach allows for greater intensity and less fatigue, providing optimal conditions for tendon strengthening. Evidence shows that shorter contractions yield similar benefits for pain relief compared to traditional longer durations but also support tendon adaptations, which were previously thought unattainable in pathological cases. By focusing on intense, short-duration isometrics, clinicians can enhance the rehabilitation process for patients dealing with tendon issues.
The Evolving Landscape of Adjunctive Treatments
Current research indicates that many adjunctive therapies for tendon pain, such as platelet-rich plasma (PRP) and shockwave therapy, lack supportive evidence for effectiveness. Comprehensive studies show that these treatments often do not yield better outcomes than placebo interventions, highlighting the need for a critical evaluation of their application in clinical practice. This trend underscores the importance of returning to foundational principles of loading and exercise therapy, which have consistently shown more promise in treating tendon-related pain. Clinicians are encouraged to focus on established rehabilitation strategies and educate patients about realistic expectations regarding adjunctive treatments.
In this episode we welcome back renowned tendinopathy expert, Professor Peter Malliaras, for a 2025 Tendinopathy Rehabilitation Update.
As a leading physiotherapist, researcher, and director at Monash University’s Musculoskeletal Research Unit, Peter shares the latest advancements in managing and rehabilitating tendon injuries.
Peter continues to provide cutting-edge insights into evidence-based treatments for persistent tendon symptoms. Whether you're an athlete dealing with tendinopathy or a practitioner looking to refine your approach, this episode is packed with valuable takeaways to help you stay at the forefront of tendon rehabilitation.
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