Etiology and pathophysiology of chronic tendon disorders in sports

Abstract

In sports medicine, a chronic overuse injury is defined as a long‐standing or recurring orthopedic problem and pain in the musculoskeletal system, which started during exertion due to repetitive tissue microtrauma (1). Repetitive microtrauma, which is basically repeated exposure of the musculoskeletal tissue to low‐magnitude forces, results in injury at the microscopic level, and no single acute trauma is normally involved in the pathogenesis of an overuse injury. In chronic tendon disorders, ‘overuse’implies that the tendon has been strained repeatedly to 44% strain until unable to endure further tension, whereupon injury occurs (2). The structure of the tendon is disrupted micro‐ or macroscopically by this repetitivestrain, i.e. collagen fibers begin to slide past one another, causing breakage of their cross‐linked structure, and denaturate; inflammation, edema and pain result. Thus, tendinitis, peritendinitis, tenosynovitis, insertion tendinitis, tendinous bursitis or apophysitis is the earliest clinically recognizable manifestation of overuse tendon injury (3).

Sonography of chronic Achilles tendinopathy: A case–control study

“…1 Although it is a common condition, its etiology and pathogenesis remain unclear. 2 Several factors such as increasing age, overloading (particularly related to sports or ballet dancing), previous injury, rheumatologic disease, and hypercholesterolemia have all been associated with chronic Achilles tendinopathy. [3][4][5][6] It is postulated that for exercise-related cases, the tendon may have been repeatedly strained beyond physiologic extensibility.…”

“…The normal healing process of the tendon is then disturbed and a cycle of chronic tendinopathy and symptoms ensues. 2 Sonography is commonly used to evaluate the Achilles tendon and paratendinous structures (subcutaneous tissues, Kager's fat pad [or preAchilles fat pad], bursae, calcaneal insertion, and plantar fascia). Although some features relating to chronic Achilles tendinopathy have been described previously, [7][8][9][10][11][12][13] there are no established sonographic diagnostic criteria for this entity.…”

Ultrasound-Guided EPI® Technique and Eccentric Exercise, New Treatment for Achilles and Patellar Tendinopathy Focused on the Region-Specific of the Tendon

“…It is tendons play an essential role in the musculoskeletal system by transferring the tensile loads from muscle to bone so as to enable joint motion and stabilization [2]. Despite this ability to adapt to physiological loads tendinopathies it represents a clinical problem which affects both professional and recreational athletes as well as people involved in repetitive work [3,4]. Tendinopathies overuse represents 30 to 50 % of all sports injuries and result in a significant amount of morbidity and spending health care [5], it is estimated that they could cost the United States health system some 30 billion dollars, annually [6].…”

Traditional Martial Arts Training Enhances Balance and Neuromuscular Control in Female Modern Martial Artists

“…Without adequate proprioception and neuromuscular control, joint stabilisation relies purely on the passive restraint provided by the ligament and joint structures, leading to functional instability [4]. This results in excessive and repetitive loading of these passive structures that can lead to microtrauma of the involved tissues that, over time, can result in chronic inflammation, weakening of the structures, and eventual rupture [5,6]. Optimising proprioception and neuromuscular control around a joint, therefore, is essential to ensure correct movement biomechanics and improve markers of performance [7,8].…”