Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00049852.xml
MSK – Muskuloskelettale Physiotherapie 2024; 28(01): 49-62
DOI: 10.1055/a-2204-4686
DOI: 10.1055/a-2204-4686
CPTE-Fortbildung
Therapie und Training bei Tendinopathien
Tendinopathien sind ein häufiges Krankheitsbild in der physiotherapeutischen Praxis, und es stellt sich die Frage, wie wirksam trotz der Schmerzsymptomatik Therapie und Training sind. Dies vor allem auch vor dem Hintergrund, dass der genaue Mechanismus für das Entstehen einer Tendinopathie nicht vollständig geklärt ist. Dieser Refresher-Artikel erklärt die aktuellen Hypothesen zur Entstehung einer Tendinopathie und zeigt Therapieansätze sowie Trainingsprinzipien für das im Wesentlichen überlastungsinduzierte Beschwerdebild.
Publication History
Article published online:
15 February 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Riel H, Frydendal Lindstrøm C, Skovdal Rathleff M. et al. Prevalence and incidence rate of lower-extremity tendinopathies in a Danish general practice: A registry-based study. BMC Musculoskelet Disord 2019; 20: 239 DOI: 10.1186/s12891-019-2629-6.
- 2 Albers IS, Zwerver J, Diercks RL. et al. Incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population: A cross sectional study. BMC Musculoskelet Disord 2016; 17: 16 DOI: 10.1186/s12891-016-0885-2.
- 3 Malliaras P, Cook J, Purdam C. et al. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. J Orthop Sports Phys Ther 2015; 45: 887-898 DOI: 10.2519/jospt.2015.5987.
- 4 Gordis L. Epidemiology. Philadelphia: Elsevier Saunders; 2014
- 5 Millar N, Grävare Silbernagel K, Thorborg K. Tendinopathy. Nat Rev Dis Primers 2021; 7: 1 DOI: 10.1038/s41572-020-00234-1.
- 6 Millar NL, Reilly JH, Kerr SC. et al. Hypoxia: A critical regulator of early human tendinopathy. Ann Rheum Dis 2012; 71: 302-310 DOI: 10.1136/ard.2011.154229.
- 7 Järvinen TA. Neovascularisation in tendinopathy: from eradication to stabilisation?. Br J Sports Med 2020; 54: 1-2 DOI: 10.1136/bjsports-2019-100608.
- 8 Abate M, Grävare Silbernagel K, Siljeholm C. et al. Pathogenesis of tendinopathies: inflammation or degeneration?. Arthritis Res Ther 2009; 11: 235 DOI: 10.1186/ar2723.
- 9 Docking SI, Cook J. Pathological tendons maintain sufficient aligned fibrillar structure on ultrasound tissue characterization (UTC). Scand J Med Sci Sports 2016; 26: 675-683 DOI: 10.1111/sms.12491.
- 10 Parkinson J, Samiric T, Ilic MZ. et al. Involvement of proteoglycans in tendinopathy. J Musculoskelet Neuronal Interact 2011; 11: 86-93 PMID: 21625045
- 11 Hackett L, Millar NL, Lam P. et al. Are the Symptoms of Calcific Tendinitis Due to Neoinnervation and/or Neovascularization?. J Bone Joint Surg Am 2016; 98: 186-192 DOI: 10.2106/JBJS.O.00417.
- 12 Järvinen M, Józsa L, Kannus P. et al. Histopathological findings in chronic tendon disorders. Scand J Med Sci Sports 1997; 7: 86-95 DOI: 10.1111/j.1600-0838.1997.tb00124.x.
- 13 Xu Y, Murrell GAC. The basic science of tendinopathy. Clin Orthop Relat Res 2008; 466: 1528-1538 DOI: 10.1007/s11999-008-0286-4.
- 14 Vaughn NH, Stepanyan H, Gallo RA. et al. Genetic Factors in Tendon Injury: A Systematic Review of the Literature. Orthop J Sports Med 2017; 5: 2325967117724416 DOI: 10.1177/2325967117724416.
- 15 Sprague AL, Couppé C, Pohlig RT. et al. Pain-guided activity modification during treatment for patellar tendinopathy: A feasibility and pilot randomized clinical trial. Pilot Feasibility Stud 2021; 7: 58 DOI: 10.1186/s40814-021-00792-5.
- 16 Silbernagel KG, Thomeé R, Eriksson BI. et al. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: A randomized controlled study. Am J Sports Med 2007; 35: 897-906 DOI: 10.1177/0363546506298279.
- 17 Thomeé R. A comprehensive treatment approach for patellofemoral pain syndrome in young women. Phys Ther 1997; 77: 1690-1703 DOI: 10.1093/ptj/77.12.1690.
- 18 Hasani F, Haines T, Munteanu SE. et al. LOAD-intensity and time-under-tension of exercises for men who have Achilles tendinopathy (the LOADIT trial): A randomised feasibility trial. BMC Sports Sci Med Rehabil 2012; 13 DOI: 10.1186/s13102-021-00279-z.
- 19 Magnusson SP, Kjaer M. The impact of loading, unloading, ageing and injury on the human tendon. J Physiol 2019; 597: 1283-1298 DOI: 10.1113/JP275450.
- 20 Hopkins C, Fu SC, Chua E. et al. Critical review on the socio-economic impact of tendinopathy. Asia Pac J Sports Med Arthrosc Rehabil Technol 2016; 4: 9-20 DOI: 10.1016/j.asmart.2016.01.002.
- 21 Ohberg L, Alfredson H. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis?. Knee Surg Sports Traumatol Arthrosc 2004; 12: 465-470 DOI: 10.1007/s00167-004-0494-8.
- 22 Merkel MFR, Hellsten Y, Magnusson SP. et al. Tendon blood flow, angiogenesis, and tendinopathy pathogenesis. Translat Sports Med 2012; 4: 756-771 DOI: 10.1002/tsm2.280.
- 23 Rees JD, Wolman RL, Wilson A. Eccentric exercises; why do they work, what are the problems and how can we improve them?. Br J Sports Med 2009; 43: 242-246 DOI: 10.1136/bjsm.2008.052910.
- 24 O‘Neill S, Watson PJ, Barry S. Why are eccentric exercises effective for Achilles tendinopathy?. Int J Sports Phys Ther 2015; 10: 552-562 PMID: 26347394; PMCID: PMC4527202
- 25 Grävare Silbernagel K, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train 2020; 55: 438-447 DOI: 10.4085/1062-6050-356-19.
- 26 Beyer R, Kongsgaard M, Hougs Kjær B. et al. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy. Am J Sports Med 2015; 43: 1704-1711 DOI: 10.1177/0363546515584760.
- 27 De Jonge S, Tol JL, Weir A. et al. The Tendon Structure Returns to Asymptomatic Values in Nonoperatively Treated Achilles Tendinopathy but Is Not Associated With Symptoms: A Prospective Study. Am J Sports Med 2015; 43: 2950-2958 DOI: 10.1177/0363546515605077.
- 28 Rudavsky A, Cook J. Physiotherapy management of patellar tendinopathy (jumper‘s knee). J Physiother 2014; 60: 122-129 DOI: 10.1016/j.jphys.2014.06.022.
- 29 Lim HY, Wong SH. Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. Physiother Res Int 2018; 23: e1721 DOI: 10.1002/pri.1721.
- 30 Reynolds JM, Gordon TJ, Robergs RA. Prediction of one repetition maximum strength from multiple repetition maximum testing and anthropometry. J Strength Cond Res 2006; 20: 584-592 DOI: 10.1519/R-15304.1.
- 31 Beyer R, Kongsgaard M, Hougs Kjær B. et al. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. Am J Sports Med 2015; 43: 1704-1711 DOI: 10.1177/0363546515584760.
- 32 Chaves P, Simões D, Paço M. et al. Deep Friction Massage in the Management of Patellar Tendinopathy in Athletes: Short-Term Clinical Outcomes. J Sport Rehabil 2020; 29: 860-865 DOI: 10.1123/jsr.2019-0046.
- 33 Joseph MF, Taft K, Moskwa M. et al. Deep friction massage to treat tendinopathy: a systematic review of a classic treatment in the face of a new paradigm of understanding. J Sport Rehabil 2012; 21: 343-353 DOI: 10.1123/jsr.21.4.343.
- 34 Loew LM, Brosseau L, Tugwell P. et al. Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis. Cochrane Database Syst Rev 2014; 2014: CD003528 DOI: 10.1002/14651858.
- 35 Hutchison AM, Evans R, Bodger O. et al. What is the best clinical test for Achilles tendinopathy?. Foot Ankle Surg 2013; 19: 112-117 DOI: 10.1016/j.fas.2012.12.006.
- 36 Maffulli N, Longo UG, Kadakia A. et al. Achilles tendinopathy. Foot Ankle Surg 2020; 26: 240-249 DOI: 10.1016/j.fas.2019.03.009.
- 37 Maffulli N, Kenward MG, Testa V. et al. Clinical diagnosis of Achilles tendinopathy with tendinosis. Clin J Sport Med 2003; 13: 11-15 DOI: 10.1097/00042752-200301000-00003.
- 38 Hirschmüller AK, Weisskopf L. Behandlungsstrategien bei Tendinopathien der Achillessehne. Arthroskopie 2018; 31: 147-154 DOI: 10.1007/s00142-018-0196-8.
- 39 Hoksrud A, Ohberg L, Alfredson H. et al. Color Doppler ultrasound findings in patellar tendinopathy (jumper‘s knee). Am J Sports Med 2008; 36: 1813-1820 DOI: 10.1177/036354650831989.
- 40 Reach JS, Nunley JA. Ultrasound Examination of the Achilles Tendon. In: Nunley JA (ed). The Achilles Tendon: Treatment and Rehabilitation. New York: Springer; 2009
- 41 Ohberg L, Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med 2002; 36: 173-175 DOI: 10.1136/bjsm.36.3.173.
- 42 Howell MA, Catanzariti AR. Flexor Hallucis Longus Tendon Transfer for Calcific Insertional Achilles Tendinopathy. Clin Podiatr Med Surg 2016; 33: 113-123 DOI: 10.1016/j.cpm.2015.07.002.
- 43 Yao G, Chen J, Duan Y. et al. Efficacy of Extracorporeal Shock Wave Therapy for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. Biomed Res Int 2020; 2020: 2064781 DOI: 10.1155/2020/2064781.
- 44 Mani-Babu S. et al. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med 2015; 43: 752-761 DOI: 10.1136/bjsports-2016-097347.
- 45 Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: a randomized controlled trial. Am J Sports Med 2009; 37: 463-470 DOI: 10.1177/0363546508326983.
- 46 Rompe JD, Furia J, Maffulli N. Mid-portion Achilles tendinopathy – Current options for treatment. Disabi Rehabil 2008; 30: 1666-1676 DOI: 10.1080/09638280701785825.
- 47 Heinemeier KM, Schjerling P, Øhlenschlæger TF. et al. Carbon-14 bomb pulse dating shows that tendinopathy is preceded by years of abnormally high collagen turnover. FASEB J 2018; 32: 4763-4775 DOI: 10.1096/fj.201701569R.
- 48 Morath O, Kubosch EJ, Taeymans J. et al. The effect of sclerotherapy and prolotherapy on chronic painful Achilles tendinopathy-a systematic review including meta-analysis. Scand J Med Sci Sports 2018; 28: 4-15 DOI: 10.1111/sms.12898.
- 49 Taylor DW, Petrera M, Hendry M. et al. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. Clin J Sport Med 2011; 21: 344-352 DOI: 10.1097/JSM.0b013e31821d0f65.
- 50 Zhang YJ, Xu SZ, Gu PC. et al. Is Platelet-rich Plasma Injection Effective for Chronic Achilles Tendinopathy? A Meta-analysis. Clin Orthop Relat Res 2018; 476: 1633-1641 DOI: 10.1007/s11999.0000000000000258.
- 51 Liu CJ, Yu KI, Bai J. et al. Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis. Medicine (Baltimore) 2019; 98: e15278 DOI: 10.1097/MD.0000000000015278.
- 52 Nauwelaers AK, Van Oost L, Peers K. Evidence for the use of PRP in chronic midsubstance Achilles tendinopathy: A systematic review with meta-analysis. Foot Ankle Surg 2021; 27: 486-495 DOI: 10.1016/j.fas.2020.07.009.
- 53 Boesen AP, Hansen R, Boesen MI. et al. Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study. Am J Sports Med 2017; 45: 2034-2043 DOI: 10.1177/0363546517702862.
- 54 Ebbesen BH, Mølgaard CM, Olesen JL. et al. No beneficial effect of Polidocanol treatment in Achilles tendinopathy: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 2018; 26: 2038-2044 DOI: 10.1007/s00167-017-4675-7.
- 55 Lynen N, De Vroey T, Spiegel I. et al. Comparison of Peritendinous Hyaluronan Injections Versus Extracorporeal Shock Wave Therapy in the Treatment of Painful Achilles‘ Tendinopathy: A Randomized Clinical Efficacy and Safety Study. Arch Phys Med Rehabil 2017; 98: 64-71 DOI: 10.1016/j.apmr.2016.08.470.
- 56 Capasso G, Maffulli N, Testa V. et al. Preliminary results with peritendinous protease inhibitor injections in the management of Achilles tendinitis. J Sports Traumatol Rel Res 1993; 15: 37-43
- 57 Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; 376: 1751-1767 DOI: 10.1016/S0140-6736(10)61160-9.
- 58 Assem Y, Arora M. Glyceryl trinitrate patches – An alternative treatment for shoulder impingement syndrome. J Orthop Translat 2014; 3: 12-20 DOI: 10.1016/j.jot.2014.11.001.
- 59 Millar NL, Murrell GA, McInnes IB. Inflammatory mechanisms in tendinopathy – towards translation. Nat Rev Rheumatol 2017; 13: 110-122 DOI: 10.1038/nrrheum.2016.213.
- 60 D‘Addona A, Maffulli N, Formisano S. et al. Inflammation in tendinopathy. Surgeon 2017; 15: 297-302 DOI: 10.1016/j.surge.2017.04.004.
- 61 Lohrer H, David S, Nauck T. Surgical treatment for achilles tendinopathy – a systematic review. BMC Musculoskelet Disord 2016; 17: 207 DOI: 10.1186/s12891-016-1061-4.
- 62 Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN. et al. Treatment for insertional Achilles tendinopathy: a systematic review. Knee Surg Sports Traumatol Arthrosc 2013; 21: 1345-1355 DOI: 10.1007/s00167-012-2219-8.
- 63 Lempainen L, Sarimo J, Mattila K. et al. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009; 37: 727-734 DOI: 10.1177/0363546508330129.
- 64 Lang G, Pestka JM, Maier D. et al. Arthroscopic patellar release for treatment of chronic symptomatic patellar tendinopathy: long-term outcome and influential factors in an athletic population. BMC Musculoskelet Disord 2017; 18: 486 DOI: 10.1186/s12891-017-1851-3.