Investigations on tendinopathy : from biomechanical etiology to novel treatment approaches

Chronic tendinosis presents a considerable challenge for the health care professional treating either an athletic or sedentary population. Recent contributions from the literature assist in our understanding of the pathomechanics of overuse tendon injuries and provide greater understanding for potential new treatments. Nevertheless, our knowledge of the causative factors for tendinopathy remains incomplete and no standardized treatment protocol has been identified. The research performed in this dissertation was intended to provide the clinician with an insight on two areas related to overuse tendinopathy: etiology and treatment. The specific objectives of the following studies include: understanding the contributions of movement patterns in tendinopathy at two sites in the lower-extremity, further our knowledge behind autologous blood injections as a treatment for tendinopathy, and provide preliminary evidence to the clinical efficacy for two experimental treatment approaches: a physiotherapy regimen incorporating dynamic stretches and balance exercises utilizing novel ultra-flexible footwear, and ultrasound guided hyperosmolar dextrose injections. Our results indicate that there is may be an association between lower-extremity movement patterns and the occurrence of Achilles tendinopathy through differences in total eversion displacement of the sub-talar joint during the touchdown phase of running. While preliminary evidence from the literature of autologous blood injections appear promising, platinum-level evidence from well designed clinical trials must contend with the high degree of variability in the dose of the bioactive ingredients therein. An exercise-based treatment program incorporating multiple training elements appears to significantly improve the pain in a population with chronic plantar fasciitis, and performing these exercises wearing a soft, ultra-flexible shoe results in a faster improvement in pain. Lastly, sonographically guided injections of hyperosmolar dextrose emerge as a safe and effective treatment for recalcitrant tendinosis at the Achilles insertion, mid-portion, infrapatellar tendon and plantar fascia.Medicine, Faculty ofMedicine, Department ofExperimental Medicine, Division ofGraduat