by ptfadmin | Jul 10, 2025 | Health Tips
Reviewed by Madison Hof
Introduction
Treatment for tendinopathies should be viewed as a multimodal approach, targeting not only the peripheral tissue but the neuromuscular adaptations that occur with persistent pain as well. Addressing the corticospinal control of the muscle by motor activation as a result of excitatory and inhibitory inputs ultimately affects tendon loading and motor production. It is important to consider neuromuscular control of the asymptomatic side as well, comparing side-to-side differences as well as differences in motor control in people with and without tendinopathy.
Motor control in people with and without tendinopathy
Muscle strength is often studied in tendinopathy research as compared to motor control. It has been understood that there is no consistent pattern of strength or performance change (increase or decrease) in tendons being studied such as in Achilles, patellar and RTC tendinopathies as well as in diagnosis such as lateral epicondylalgia. Strength deficits coupled with the presence of tendinopathy has not been consistently demonstrated in past research to reasonably target the peripheral tissue’s power production alone without assessing the neuromuscular component of muscle activation.
Imbalances in recruitment ability of excitatory and inhibitory influences around the painful tendon during muscle loading were found when comparing symptomatic and asymptomatic sides of athletes with patella tendinopathy (PT). It has been hypothesized that a protective adaptation occurs, reducing the mechanical demand that is placed on the tendon. Both peripheral and central contributions are associated with motor control changes and those with PT demonstrated landing mechanic patterns with less variability than to those without PT. Motor patterns that are invariable implies that control coming from the corticospinal tract is altered and may be due to protective strategies. Jumping abilities with less variability has been shown to be a risk factor for developing PT. In fact, these individuals were shown to be better jumpers than those without PT, coining this phenomenon the ‘jumper’s knee paradox’. Therefore, movement variability has been hypothesized as an important attribute in preventing injury.
Pain is commonly accompanied with changes in motor control as an adaptive mechanism that protects us from bodily threat. Motor control while having painful symptoms is altered due to the corticospinal drive to the motor neuron or muscle. Furthermore, there were no differences in muscle strength or activation between groups suggesting that the motor task can cause a potential pain response during jumping even in the absence of nocioception.
Motor control changes may be bilateral
Side-to-side strength deficits were found to be low following unilateral Achilles tendinopathy surgery which may reflect bilateral motor control deficits. These changes following tendinopathy pain may also be system wide which can be due to intrinsic and extrinsic factors, potentially increasing the risk of tendinopathy elsewhere in the body. An increase in global sympathetic drive implies the nervous systems’ involvement in tendinopathies. For example, there is increased inhibition responses on an affected limb following a stroke and an increased corticospinal excitatory response on the unaffected limb. This indicates an increased interhemispheric inhibition from the non-affected hemisphere to the lesioned hemisphere leading to further inhibition on the affected limb during activation of the unaffected limb. Changes in the unaffected side associated with tendinopathies may be the bodies way to attempt motor control homeostasis while trying to protect a region. This may also explain the high injury prevalence of the contralateral tendon following rehabilitation.
Conclusion and clinical implications
In order to address the differences in excitability and inhibition, an alteration to corticospinal control of muscles must be acknowledged as seen in different motor strategies used for protection. Movement variability should be considered following musculoskeletal pain even if nocioceptive input is absent due to the fact that altered motor control could be transmitted to a tendon causing a continuation of previous nocioceptive input. Altered invariable movement patterns that occur with pain are presumed to optimize performance subconsciously. This is demonstrated in those with tendinopathy displaying superior strength and performance despite having inflamed peripheral tissues. Strength training is often the focus for individuals with tendinopathy to stimulate the physiological adaptation of the muscle/tendon, but it is now known that it can modulate pain and corticospinal control of the muscle as well. Rehabilitation should be considered bilaterally to address the unaffected side as well to prevent contralateral motor adaptations from developing.
References
Rio E, Kidgell D, Moseley GL, et al. Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. British Journal of Sports Medicine. 2015;50(4):209-215. doi:https://doi.org/10.1136/bjsports-2015-095215
by ptfadmin | Jul 3, 2025 | Health Tips
Introduction/Background
Carpal tunnel syndrome is a prevalent condition characterized by compression of the median nerve within the carpal tunnel pf the wrist, leading to symptoms such as numbness, tingling, and weakness in the hand. Conventional treatments include wrist splinting, corticosteroid injections, and surgical intervention. However, there is a growing interest in non-invasive, self-administered therapies that empower patients to manage their symptoms.
Methods
The double-blinded randomized controlled trial 40 participants diagnosed with mild to moderate CTS. Participants were randomly assigned to either the intervention group, which performed a specific self-stretching exercise targeting the carpal ligament, or the control group, which performed a sham stretching exercises. The intervention consisted of a daily stretching routine over a period of four weeks.
The study found that participants in the self-stretching group experienced a statistically significant improvement in symptom severity, as measured by the Boston Carpal Tunnel Questionnaire. Additionally, there was a notable increase in pinch strength among these participants compared to the control group. No adverse effects were reported, indicating the safety of the self-stretching technique.
Conclusion
The findings suggest that self-administered stretching of the carpal ligament can be an effective non-invasive treatment for reducing symptoms and enhancing pinch strength, therefore, improving hand function in individuals with CTS. This approach offers a cost-effective and accessible option for patient, potentially reducing the need for more invasive treatments. The study emphasizes the importance of patient education and adherence to the stretching regimen to achieve optimal outcomes.
References
Shem K, Wong J, Dirlikov B. Effective self-stretching of carpal ligament for the treatment of carpal tunnel syndrome: A double-blinded randomized controlled study. J Hand Ther. 2020 Jul- Sep;33(3):272-280. doi:10.1016/j.jht.2019.12.002. Epub 2020 May 1.PMID: 32362377.https://www.jhandtherapy.org/article/S0894-1130(20)30001-6/fulltext
by ptfadmin | Jun 26, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction/Background
The article introduces a four-stage plyometric training program as part of criterion-based rehabilitation for athletes post-ACLR. It emphasizes the importance of aligning plyometric tasks with the patient’s functional recovery status, considering factors like task intensity, momentum, ground contact time, and surface. The goal is to enhance neuromuscular function, movement quality, and reduce injury risk, facilitating a timely return to sport.
Post-ACLR, many athletes struggle to return to their previous performance levels and are at a heightened risk of re-injury. Deficits in neuromuscular performance, such as reduced strength and movement asymmetries, are common. Plyometric training involves rapid muscle lengthening followed by shortening, is highlighted as an effective method to improve explosive performance and neuromuscular control, surpassing traditional resistance training in some aspects.
This article aims to provide clinicians with a guideline on designing and implementing plyometric programs tailored to the ACLR patient’s recovery stage.
Methods
The program is divided into four stages, each aligned with specific phases of rehabilitation:
- Stage 1 (Mid-Stage Rehabilitation): Focuses on foundational movements with low intensity, emphasizing control and technique.
- Stage 2 (Late-Stage Rehabilitation): Introduces moderate-intensity exercises, incorporating more dynamic movements while maintain control.
- Stage 3 (Late-Stage Rehabilitation): Advances to higher-intensity plyometrics, emphasizing power and agility in preparation for sport-specific activities.
- Stage 4 (Return-to-Sport Training): Involves high-intensity, sport-specific plyometric exercises to simulate real-game scenarios, ensuring readiness for return to sport.
Each stage considers task intensity, movement complexity, and the athlete’s ability to perform exercises with proper technique. Progression through stages is based on meeting specific criteria, ensuring safety and effectiveness.
The article emphasizes the importance of continuous monitoring throughout the rehabilitation process. Clinicians should assess movement quality, control in both frontal and sagittal planes, and the athlete’s response to increasing exercise intensity. If an athlete cannot perform tasks with minimum competency, exercises should be simplified. Daily monitoring of pain, swelling, and soreness is recommended to guide progression and prevent setbacks.
Conclusion
Plyometric training is a crucial component of functional recovery post-ACLR. A structured, criterion-based approach ensures that exercises are matched to the athlete’s recovery status, promoting neuromuscular reconditioning and reducing the risk of re-injury. Clinicians are encouraged to integrate this four-stage program into rehabilitation protocols to optimize outcomes for ACLR patients.
References
Buckthorpe, M., and Della Villa, F. (2021). Recommendations for Plyometric Training after ACL reconstruction: A Clinical Commentary. International Journal of Sports Physical Therapy, 16(3), 879-895. https://doi.org/10.26603/001c.23549
by ptfadmin | Jun 19, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction/Background
Chronic low back pain is complex and often not explained by a structural pathology alone. Modern pain neuroscience suggest that persistent pain may be due to maladaptive neuroplastic changes. In this article, the authors introduce Graded Motor Imagery (GMI). GMI is a three-stage neurorehabilitation approach (left/right discrimination, explicit motor imagery, mirror therapy) designed to treat chronic pain by altering the central nervous system processing.
Methods
A 67-year-old female with a 30 year history of chronic LBP participated in the study. Her pain significantly impacted her quality of life and daily function. Prior treatments- medications, injections, physical therapy, provided limited relief. The patient was introduced to GMI as an alternative strategy.
Initial assessment revealed central sensitization, pain-related fear, and body perception disturbances. Outcomes included the Oswestry Disability Index (ODI), Pain Catastrophizing Scale (PCS), and the Fremantle Back Awareness Questionnaire (FreBAQ). The results showed high disability and distorted body perception.
GMI was introduced in three graded stages over several weeks:
- Left/Right Discrimination: The patient identified images of backs as left or right to stimulate sensorimotor processing.
- Explicit Motor Imagery: She visualized moving her back without actually moving.
- Mirror Therapy: Movements were performed with a mirror to stimulate normal movement and reduce fear and pain.
The intervention was tailored to her tolerance, emphasizing progression without exacerbating symptoms.
Results
After the GMI program, the patient reported:
- Reduced pain and disability (improved ODI scores)
- Improved body awareness (better FreBAQ scores)
- Lower fear and catastrophizing thought (reduced PCS)
She was able to return to activities she had previously avoided due to pain.
Discussion
The report highlights GMI’s potential to target central nervous system changes underlying chronic pain. It emphasizes the importance of treating not just tissue damage but also the brain’s perception of the body. The results support the integration of GMI into pain rehabilitation, particularly for patients with evidence of central sensitization and distorted body image.
Conclusion
GMI was an effective, low-cost, and non-invasive that helped reduce pain and disability in a patient with longstanding chronic LBP. The case supports its use as part of a multidisciplinary pain management approach.
References
Iglar, D., Dritsas, J., and Cortese, F. (2021). Monkey see, monkey do: Using graded motor imagery in the management of chronic low back pain- A case report. Journal of Orthopaedic & Sports Physical Therapy, 51(1), 41-41.. https://doi.org/10.2519/jospt.2021.9966
by ptfadmin | Jun 13, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction/Background
Chronic lateral ankle instability is a common issue that can result from repeated ankle sprains, leading to ligamentous laxity and functional impairment. The traditional Broström procedure has been widely used to restore ankle stability by directly repairing the lateral ankle ligaments. However, concerns remain regarding early failure due to inadequate ligament healing and the need for prolonged immobilization during rehabilitation.
Methods
A retrospective review of 93 patients who underwent the suture tape-augmented Broström procedure was conducted. The inclusion criteria were patients with persistent ankle instability despite conservation management. The exclusion criteria included prior ankle surgery, severe osteoarthritis, and neurological deficits affecting ankle stability.
The surgical technique involved performing a standard Broström repair, followed by reinforcing the lateral ankle ligament complex with a non-absorbable suture tape anchored into fibula and talus. This augmentation was designed to provide additional mechanical support while still permitting natural joint motion.
Postoperatively, patients followed an accelerated rehabilitation protocol that emphasized early weight-bearing and functional exercises. Outcomes were assessed based on complication rates, re-injury occurrences, and the timeline for returning to unrestricted activity.
Results
None of the patients experienced failure of the repair or recurrent instability during the follow-up period. Compared to traditional protocols, the suture tape augmentation allowed for an accelerated return to functional activity. Military personnel resumed agility drills approximately four weeks earlier than conventional rehabilitation protocols would typically permit. There were no significant postoperative complications such as infections, deep vein thrombosis, or hardware-related irritation. Patients reported minimal pain and swelling, and none required surgical revision.
Discussion
The study’s finding suggests that suture tape augmentation in the Broström procedure provides significant advantages over traditional repair methods. The reinforcement from the suture tape allows for immediate post-surgical stability, reducing the risk of failure due to early ligament stretching. This added support enables earlier weight-bearing and a more aggressive rehabilitation approach, which is particularly beneficial for high-performance populations such as athletes and military personnel.
Additionally, the study highlights that while some surgeons may hesitate to introduce synthetic augmentation into soft tissue repairs due to concerns about long-term biocompatibility, the suture tape used in this procedure did not result in adverse reactions. The ability to maintain the native ligament’s natural function while providing supplemental stability makes this approach a promising alternative to conventional Broström repair.
Potential limitations of the study include its retrospective nature and the lack of long-term follow-up data. Future research should focus on randomized controlled trials to compare suture tape-augmented repairs directly with traditional Broström procedures over extended periods.
Conclusion
The suture tape-augmented Broström procedure is a safe and effective technique for treating chronic lateral ankle instability. It provides immediate mechanical stability, reduces the risk of failure, and allows for early functional rehabilitation without increasing the likelihood of complications. Given these benefits, the procedure may be particularly well-suited for individuals who require a rapid return to activity, such as military personnel and athletes. This study supports wider adoption of this technique in clinical practice and suggests that it could improve surgical outcomes for patients with chronic ankle instability.
References
Martin, K. D., Old, S. B., Dauer, E. A., Hutton, J. R., & Bahr, R. A. (2020). Suture tape-augmented Broström procedure and early accelerated rehabilitation: A retrospective comparison of augmented and nonaugmented repair. Foot & Ankle International, 41(12), 1523-1532. https://doi.org/10.1177/1071100720959015
by ptfadmin | Jun 5, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction/Background
This systemic review examines the incidence and prevalence of running related musculoskeletal injuries (RRMIs). The knee, ankle, and lower leg are thr most commonly injured sites, with Achilles tendinopathy and patellofemoral pain syndrome being prevalent. It was found that there are no significant differences between ultramarathoners and non-ultramarathoners. Running has numerous health benefits but also a high rate of overuse injuries. Updated epidemiological datais needed for better prevention and rehabilitation.
Methods
A systematic search was conducted in SPORTDiscus, PubMed, and Medline databases up to
June 2020, with date restrictions. Prospective studies were included for incidence data, while
retrospective or cross-sectional studies were used for prevalence data. The analysis also
separately considered ultramarathon runner to identify any differences in injury patterns
Results
Overall injury rates:
The mean injury incidence was 40.2%, and the mean prevalence was 44.6%.
Anatomical locations:
Incidence: Knee (27.0%, ankle (25%), lower leg (23%). Prevalence:
knee (28%), lower leg (16%), and foot/toes (14%).
Specific pathologies:
Incidence: Achilles tendinopathy (10.3%, medial tibial stress syndrome
(6.3%), plantar fasciitis (6.1%), ankle sprains (5.8%). Prevalence: Patellofemoral pain syndrome
(16.7%), medial tibial stress syndrome (9.1%), plantar fasciitis (7.9%), iliotibial band syndrome
(7.9%), Achilles tendinopathy (6.6%)
Ultramarathoners:
Similar injury distribution, with anterior compartment tendinopathy (19.4%)
being notable, patellofemoral pain syndrome (15.8%), and Achilles tendinopathy (13.7%).
No significant difference in injury incidence proportions by anatomical location were found
between ultramarathoners and non-ultramarathoners.
Discussion
Knee and ankle injuries dominate, with Achilles tendinopathy and patellofemoral pain syndrome being most prevalent.. Most likely due to biomedical demands and repetitive stress. It also notes limitations in included studies due to inconsistent injury definitions and varying study designs which may affect the interpretation of epidemiological data.
Findings suggest need for future research and consistent injury definitions.
References
Kakouris, N., Yener, N., & Fong, D. T.-P. (2021). A systematic review of running-related
musculoskeletal injuries in Runners. Journal of Sports Science & Medicine
https://doi.org/10.52082/jssm.2021.672
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